Breast Cancer in Hawai‘i
Why aren’t Island women getting mammograms?
"What if they find something? I don't know if I could deal with that!" remarks Priscilla Batul, an 'Ewa Beach resident, when asked what she fears most about having her yearly mammogram. As a clinic aide in a doctor's office, she knows how important it is to stay healthy, and recalls that her first test wasn't that bad. "It was uncomfortable, but not really painful." However, she readily admits that her biggest fear is hearing there's something wrong. "Even though I see a lot of women who have had breast cancer and look healthy, it's still hard to think that it could be you." And Batul is right to be concerned: More than 200,000 women will be diagnosed with breast cancer in the United States this year, and more than 40,000 women lose their lives annually to this disease.
Hawai'i ranks 43rd in the nation in the number of women between the ages of 40 and 64 who have their yearly mammograms. Recent studies have shown that Filipinos and Native Hawaiians have the lowest rates of mammograms in the state. This may explain why Hawaiians have the third-highest breast cancer mortality rate in the nation. Mammography done every year or two in a woman over the age of 50 may reduce her risk of dying from breast cancer by 30 percent. So why aren't women getting mammograms?
According to Dr. Ratheany Sakbun, of North Hawai'i Community Hospital, the most common reason is fear-and wishful thinking. Many women are afraid that the test is going to hurt, or afraid of finding out that they have cancer, or think that cancer won't happen to them. However, Sakbun points out, "Most women with breast cancer have no family history of the disease, and aren't aware of their risk factors or how important this test is."
It's particularly important to catch breast cancer in its early stages. Breast cancer survivor Geraldine Yamashita encourages her friends to get checked. "Mammography saved my life. My cancer was found in the earliest stages, and, after chemotherapy and radiation, I'm doing fine." She has seen many others whose cancers were far advanced by the time they were diagnosed, who did not survive.
The American Cancer Society recommends that women have yearly breast exams done by a doctor, and yearly mammograms after age 40. Women should review their exam techniques with their doctors, and then do their own self-exams every month. The best time to do a self-exam is a week after the menstrual cycle, or if in menopause, at the same time every month. (This is also the time to do a mammogram.) If possible, it's best to have mammography done at the same center every year, so that subtle changes in breast tissue can be monitored.
Mammograms are offered at most major medical centers, in addition to women's health centers across the country. In addition to the X-rays, many centers are now offering digital mammography, with computer readings, and specialized radiologists reviewing the films. Health insurers, such as HMSA, are starting to cover this additional service. The accuracy of a mammogram increases with both the computer reading and the doctor's reading, and it becomes possible to diagnose cancers in their earliest stages. Newer techniques, such as breast MRI, are now being researched across the nation. For high-risk women, this test may be better than a standard mammogram, and, in some cases, can be as accurate as a biopsy.
October is National Breast Cancer Awareness month. All women are encouraged to ask their doctors when they had their last mammograms, and to schedule their next one whenever it's due. "Although scary, finding out that everything is OK is the best peace of mind a woman can have," says Batul.