permission, Courtesy, The Star-Ledger newspaper.
LONG BRANCH, NJ, February
2, 2007 - The number of women receiving mammograms
is declining nationally and advocates of the test in New Jersey
have formed a strike force to reverse a trend many find alarming.
"There is no doubt that cancers are more curable when they are
found early. Mammography is still the gold standard for finding
them," said Melinda Staiger, who is helping lead the American
Cancer Society's mammography strike force. She also is medical
director of the breast center based at Monmouth Medical Center
in Long Branch.
From 2000 to 2005, the percentage of women age 40 and over who
reported receiving a mammogram in the previous two years fell
from 76.4 percent to 74.6 percent, says a report from the Centers
for Disease Control and Prevention.
This translates into 1.44 million fewer women getting the test.
In New Jersey, the drop was almost identical to the national
decline, going from 76.7 percent, to 74.9 percent.
The new strike force, made up of epidemiologists, radiologists
and other experts, want to know the reasons for the decline.
Low usage of mammography has been associated with factors such
as a patient's immigration status, and the lack of a primary
care physician or health insurance.
Staiger said another problem may be that women are simply having
difficulty accessing mammography, an X-ray picture of the breast
capable of detecting cancer at an early stage, often before a
lump can be felt.
In New Jersey, the number of facilities performing mammography
has declined, from 278 in 2001 to 250 in 2004. Low reimbursement,
along with the cost of maintaining equipment and retaining qualified
personnel, are factors in the drop-off, experts say.
There are strict federal rules in place to ensure high-quality
screenings, and on-site inspections focus on everything from
the image quality to the qualifications and training of personnel.
In 2004, one of every four New Jersey mammogram sites failed
to comply with federal rules and were cited for violations. About
75 percent of facilities were found to be in compliance the following
There has been a long-standing debate over the mammogram, with
some studies showing it saves lives, while others have questioned
its value. One of the most often-cited studies, sponsored by
the National Cancer Institute, was published in The New England
Journal of Medicine in October 2005.
It concluded that up to 65 percent of the sharp decrease in
breast cancer deaths from 1990 to 2000 were due to mammograms.
The rest was attributed to powerful new drug treatments.
The breast cancer mortality rate in New Jersey decreased from
34.8 per 100,000 women in 1994 to 28.5 per 100,000 women in 2003.
Still, an estimated 6,080 new cases of breast cancer will be
diagnosed in New Jersey women this year, and more than 1,300
women are expected to die from the disease.
"You never get rid of a diagnostic tool until there is something
better to replace it," said Barbara Waters, education and outreach
manager for Susan G. Komen for the Cure-North Jersey, a breast
cancer education and advocacy group based in Summit.
Another area being explored by the strike force is whether uninsured
or underinsured women are finding it more difficult to get a
"When I talk to women, a lot of them say they don't have the
money," said Edward Verner, a retired Newark breast surgeon and
strong advocate of women regularly examining their own breasts
The State Department of Health and Senior Service's program
NJ CEED (Cancer Education and Early Detection) offers free mammograms
to the uninsured and underinsured.
More than 13,000 women received mammograms through the program
last year, compared with a little more than 7,000 in 2003.
"We educate women that a hands-on breast exam by a doctor is
an essential part of their screening, along with the mammogram," said
Deborah Delesantro, clinical coordinator of the CEED program
based at St. Joseph's Regional Medical Center in Paterson, which
also runs an outreach program.
The American Cancer Society recommends yearly mammograms starting
at age 40, although women at increased risk -- such as those
with a family history of breast cancer -- should talk to their
doctors about whether they need to start earlier.
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