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Doctors stand by DESPITE a debate about its effectiveness, a mammogram is the best means of detecting early breast cancer and better technology is being developed, say Hawaii doctors and screening specialists.
mammograms
For women over 40, annual
A success story
breast X-rays are touted as the
best tool to fight cancerBy Helen Altonn
haltonn@starbulletin.com"All women over age 40 should be getting a mammogram yearly," said breast surgeon Laura Hoque, medical director of Kapiolani Women's Health Center and president of the Hawaii Breast Society.
"If that were the case, I would see a lot less advanced cancers in my practice ... But we see patients all the time who haven't had a mammogram in five years and they have a big lump."
Hoque and other doctors discount several recent studies saying mammograms do not prevent deaths from breast cancer.
A report by Copenhagen researchers, criticized in the United States and Europe, stirred controversy and confusion among patients and some medical professionals about mammograms, said Dr. Scott Grosskreutz of Hilo, director of Hawaii Radiologic Associates, Ltd., East Women's Imaging Center.
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But mammography still is considered "the gold standard" for early screening, detecting about 85 percent of all breast cancers, he said."You see articles that they're not sure it will save lives," said Dr. Richard DeJournett of Koolau Radiology. "Trust me, it does. To the woman whose life was saved, they will say, 'That machine saved my life.'"
Michelle Rudoy, manager of the Women's Health Center operated by Kapiolani Medical Center for Women and Children, said it has received many calls, even from referring physicians, asking what they are telling women about mammograms in view of the controversy.
"We're saying it's still the best screening tool," she said.
Grosskreutz, whose center does about 12,000 mammograms a year, believes breast cancer is increasing because of various factors, such as Western diets, obesity, excessive use of alcohol and aging of the population, as well as better detection.
The National Cancer Center's Information Service estimates Hawaii this year will have 4,700 new cases, of which 700 will be women with breast cancer.
Grosskreutz is excited about new technologies, such as digital imaging and computer-assisted diagnosis. He said they offer promise of detecting more breast cancers at an earlier stage and preventing false negatives.
Conventional X-ray mammography is estimated to reduce deaths by 30-50 percent, but some studies indicate 15-20 percent of malignancies are missed, he said.
A Texas study of 13,000 women screened both with conventional mammography and CAD found almost 20 percent more cancers than they would have without the new technique.
Cancers often hidden by dense tissue or that overlap with fibrocystic conditions can be spotted with the advanced technology, Grosskreutz said.
Better screening also can prevent anxiety and unnecessary biopsies, he said.
Hoque said the digital procedure is faster because the technologist does not have to leave the room to develop film. "Just as you do with a digital camera, you click on a button and see the image instantaneously."
But while digital mammography has potential advantages, it has not been proven yet to be better than film, she added.
The Hawaii Breast Cancer Society, which Grosskreutz founded several years ago, is planning a "technology fair" next month for companies to demonstrate the technology to concerned groups.
"The goal right now is to have access to the best equipment we can get our hands on in order to improve breast cancer detection in Hawaii," Grosskreutz said.
However, this can't be done until Medicare, the Hawaii Medical Service Association and other insurers provide sufficient reimbursements to help pay for the equipment, he said.
Each new digital mammography unit could cost up to $500,000 and a computer-aided detection system would cost about $250,000, he said. Powerful computers also would be necessary to store images and display them on monitors, he added.
The Kapiolani center, which does about 16,000 mammograms a year, has been thinking about getting a CAD system and digital mammography, Rudoy said. "We've gone to the mainland to look at demonstration sites."
But centers with a smaller volume of patients probably could not afford it, she said.
Congress ordered Medicare to pay for computer-assisted diagnosis for Medicare patients last year and raised payments for CAD this year, Grosskreutz noted. Congress also approved higher payments for mammograms performed with new digital technology to allow providers to pay for the equipment.
However, HMSA has not approved reimbursements for the new technology and has been paying below Medicare rates for conventional mammograms, he said. The insurance carrier notified participating radiologists and hospitals this month that it will adjust mammography charges April 1 "in light of Medicare's 2002 medical services fee schedule."
DeJournett, among radiologists clamoring for the rate increase for months, said radiologists and screening centers were in danger of losing Medicare patients because it's illegal to accept reimbursements lower than what Medicare pays for services.
"We're grateful HMSA took that step," Grosskreutz said, noting some providers were concerned that they wouldn't be able to continue mammographic services.
HMSA Senior Vice President Cliff Cisco said clinical studies so far do not show better results with the new technology, but the association's medical directors will meet with radiologists within the next few weeks to discuss the issues.
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Woman shares early
detection success storyA routine annual mammogram in January caught "something abnormal" in Naomi Iha's right breast that she said couldn't be detected through a self-examination.
After a second screening last month, a biopsy was done March 15 that confirmed she had cancer in the very early stages, she said.
She's scheduled for surgery Monday at Kapiolani Medical Center for Women and Children.
"It was more of a shock than anything else," said Iha, 43, an independent contractor who does commercial property management for Action Realty. "I'm just grateful they were able to detect the microcalcifications through the mammogram."
Iha said she has had annual mammograms since she was about 38 years old on her gynecologist's recommendation.
"I'm a little leery about the radiation part of it; I don't think it should be abused. But in this case, I think it's the only way they could have found it (cancer) so soon."
A devout Christian, Iha said she has the full support and prayers of all the people at her church, Calvary Chapel in Honolulu, as well as from her parents and three brothers.
Although she's "a little scared," she said, "I have full faith in the Lord and I know He has a perfect plan for me, so I'm fine."
Moreover, she has a special occasion to look forward to, she said. "I'm engaged and being married next month."
Helen Altonn