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For the Public Health by Stuart Tedders Ph.D.
Screening for breast cancer
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    Excluding the skin cancers, breast cancer is the most commonly diagnosed cancer among women in the United States.  Breast cancer is the second most deadly form of cancer among women, accounting for approximately 15 percent of all cancer deaths.  An estimated 178,480 new cases of invasive breast cancer will be detected in the United States in 2007 and an estimated 40,460 deaths will occur.  In Georgia, 4,520 new cases of breast cancer and 1,120 deaths are expected.  All women are at risk, and many factors are thought to contribute to the increased likelihood of developing breast cancer. 
    Risks that have been linked to increased breast cancer disease and death include socioeconomic and cultural factors, such as educational attainment, annual household income, and the prohibitive cost of cancer screening and treatment. Among other breast cancer risks are biologic factors such as age, age of first menses, age at menopause, and child bearing. Other risk factors involve breast cancer knowledge and behavior, including diet, exercise, and screening for purposes of early detection, and finally, race and ethnicity.
    When one considers race, the literature suggest that white women have more new cases of breast cancer than African American women.  However, death rates are disproportionately higher among African American women.  In addition, the likelihood of surviving at least five years after being diagnosed with breast cancer is lower among African American women as compared to white women. 
    This disparity might be related, in part, to detecting the cancer at a more advanced stage of the disease.  The literature on breast cancer also suggests that racial differences in mortality might be attributable to biologically different forms of the cancer, as well as disparities in screening behaviors among white and nonwhite women.  According to several studies, nonwhite women – African American women in particular – are more likely to underutilize available screening services, which results in poorer health outcomes. 
    Many factors influence a woman’s decision to utilize breast cancer screening services, including one’s perception of risk from breast cancer.  Such individual perceptions may be shaped by any number of factors: the lack culturally competent education about the frequency of breast cancer and the benefits of early detection, a woman’s vicarious experiences with family and friends, and spiritual beliefs, to name a few. 
    According to the American Cancer Society, yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.  A clinical breast exam should also be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.  Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam is an option for women starting in their 20s. 
    Women at high risk (greater than 20 percent lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15 percent to 20 percent lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.
    Dr. Stuart Tedders is an associate professor of epidemiology in the Jiann-Ping Hsu College of Public Health at Georgia Southern University.  His recent research involves epidemiological investigations of cancer in Georgia, as well as perceptions of breast and cervical cancer risk among women enrolled in a public health cancer screening program. In 1998 he was named Rural Health Researcher of the Year by the Georgia Rural Health Association. He is a board member of the Georgia Rural Health Association and the Magnolia Coastlands Area Health Education Center.
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