Listen to reasons that women offer for avoiding a routine medical test that can detect a deadly but treatable disease in its early stages:
”I know I`m old enough to have one, but I just haven`t felt any need to have one. I feel healthy. . . . I`m one person who probably never will get it.”
”I hate them. I think they`re very painful. . . . I just think they`re embarrassing.”
”You think if you ignore a problem, it will go away. . . . If you had one this year, you figure next year you`ll be OK.”
Just 14 percent of 26,227 women over 40 whose medical claim forms were examined for a recently published Blue Cross and Blue Shield of Illinois study filed claims for mammograms in 1990 and 1991-even though they were insured and the screening X-ray exam, which usually takes less than an hour, would have cost little or nothing.
Medical experts say that is shocking.
”The benefits are possibly extremely large,” said Dr. Arnold Widen, Blue Cross vice president and medical director. ”The benefit of finding a cancer early may be the difference between life and death.”
Among the reasons cited: Some women say they are confused by mixed signals from the medical community. Reports say mammograms sometimes are administered poorly, results are misinterpreted and even that women in their 40s who take the test are more likely to die from breast cancer than women who don`t.
Fear of discovering cancer is the main reason women put off the test, said Sharon Green, executive director of Homewood, Ill.-based Y-ME National Organization for Breast Cancer Information and Support.
”Women look for any excuse,” Green said. ”Because women are so afraid of the disease, they`re less likely to have mammography.”
Widen, though, said he believes the primary reason for women`s reluctance to be screened is that they don`t want to believe that they have breast cancer.
”People tend to deny that terrible things can happen to us,” he said.
”We don`t wear seat belts. `I don`t have breast cancer.` ”
Susan Forrest, 40, should have had an exam by now, according to American Cancer Society guidelines, which recommend a baseline test for women between the ages of 35 and 39. That baseline test then can be used as a comparison for changes as the woman grows older.
Forrest, a resident of Mishawauka, Ind., hasn`t had the test and doesn`t intend to. She said she feels healthy and doesn`t consider herself a risk because her family has no history of breast cancer.
”I`m a fairly healthy person and I rarely get a cold, I rarely get a headache,” Forrest said.
The medical establishment advocates breast cancer screening every other year for women between 40 and 50; every year for women over 50.
Studies have shown a 30 percent decrease in breast cancer death rate in women over 50 who have regular mammograms, but no study has demonstrated a reduction in the death rate for women who are screened regularly between 40 and 50.
Last spring, preliminary conclusions of an unpublished Canadian study made national headlines; the research indicated that women in their 40s who had regular mammograms were more likely to die of the disease.
Critics said the study was flawed. The researchers who conducted the study refused to discuss their findings, which were leaked to the press, because they had not been published.
And a recent article in HealthFacts, a monthly newsletter published by the Center for Medical Consumers, a New York non-profit organization, suggests that the medical establishment is pushing mammograms for women under 50 because it is such a lucrative business. Five studies conducted in Europe over several years have shown that mammograms don`t improve breast cancer survival in younger women, the newsletter said.
Add to this the ongoing debate over the effects of radiation (mammograms use X-rays), and it`s easy to see why women may be skeptical of subjecting themselves to breast cancer screening.
Some women say they put off taking the test because they find it painful. It can be uncomfortable, depending on the density, not the size, of breasts, according to Cara Culmer, an internist at Women`s Health Resources of Illinois Masonic Medical Center.
And others simply don`t know what the cancer society guidelines are and their doctors don`t tell them, Y-ME`s Green said.
Addison resident Elizabeth Padgett, 71, said both are reasons she has had just three of the tests in her life.
”I hate them. I think they`re very painful,” she said of the fact that the breast must be squeezed into position on the mammogram equipment.
Padgett had a hysterectomy after being diagnosed with uterine cancer in the early 1980s. Her doctor has not told her she needs to be screened for breast cancer, so she hasn`t had the test, she said.
Blue Cross and Blue Shield said its study showed money was not a reason for avoiding the exams, because most of those in the study were fully covered. But the cost of the test, about $50 to $200, does matter to some women.
”I don`t have insurance,” said Elmhurst resident Betty Hamrick, 52, who had a mammogram three years ago when she noticed something different about one of her breasts. The test was negative.
”It`s a cost factor with me,” she said. (Some communities` health agencies do provide free mammograms.)
But Hamrick said if she had insurance, and it covered annual exams, she probably still would not be tested every year.
”Sometimes you think if you ignore a problem, it will go away,” she said.
That kind of statement would make Widen cringe. His wife, Judy Wilson, 54, a medical executive, put off her routine mammogram for 10 months, even canceling two appointments for the exam because she was busy. An examination site is two blocks from her office.
When she finally was tested, doctors not only found breast cancer, but discovered it had spread to a lymph node. She is now undergoing chemotherapy. Had she been screened earlier, the cancer probably wouldn`t have spread to the node, she said.
”I could have prevented the chemotherapy,” said Wilson, director of HMO USA, a national network sponsored by Blue Cross and Blue Shield. ”I knew the guidelines. There`s no excuse except that I was busy. I never thought it could happen to me.”
Detecting cancer early is why some women are careful to be screened regularly, despite the mixed signals from the medical community and the difficulties of fitting the test into a hectic schedule. They say they believe doctors who say the test is a life-saving screening device.
Leslie Pistilli, 43, of Glen Ellyn, has regular mammograms, especially because she watched a friend die after contracting breast cancer. The friend spent her final days-including her daughter`s wedding day-on a respirator.
”It was just awful to see,” Pistilli said. ”I`m a firm believer in preventive medicine.”
