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Why Are Fewer Women Getting Mammograms?
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Why Are Fewer Women Getting Mammograms?

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Why Are Fewer Women Getting Mammograms?

Why Are Fewer Women Getting Mammograms?
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A new Cancer Institute study finds that the number of women getting mammograms is on the decline. Dr. Ivan Walks, former Chief Health Officer for the District of Columbia, talks to Farai Chideya about the startling trend and what it means for the future of breast cancer prevention.

FARAI CHIDEYA, host:

According to the National Cancer Institute, the number of women getting mammograms has dropped over the last five years. Breast cancer will kill 40,000 women this year and be diagnosed at another 178,000. The steep decline in screenings has health professionals worried.

For more, we turn to Dr. Ivan Walks. He's former chief health officer for the District of Columbia and NEWS & NOTES resident medical expert. Welcome back.

Dr. IVAN WALKS (Former Chief Health Officer, District of Columbia): Good to be here. Thank you.

CHIDEYA: So this seems perplexing. What accounts for this drop in screenings?

Dr. WALKS: We have - it's like so many other things. We have a number of factors. Very quickly, one of them is that folks are more comfortable. Folks think that maybe they don't need to go and get screening because the overall rates are down. So there's that sort of a comfort factor.

One of the things that's really concerning to me, though, is that it's hard to get the mammogram done. And a lot of people are talking about the fact that there are fewer opportunities. If you just want to make an appointment, it may take months to get one done. So you've got the access issue, and then another one that a lot of folks are talking about is the fact that now that we know that hormone replacement therapy for women who have gone through menopause, now that's not really not as frequently recommended and folks are doing that, that was one of the things that made women worry about breast cancer.

So some of the thinking is, if you're not doing hormone replacement therapy, maybe you aren't going to your doctor as much and maybe you don't think that you need to go and have a mammogram done. All reasons why this could be resulting in a decline, and the decline is a significant concern.

CHIDEYA: How much do people know, for example, about the causes of breast cancer? There are different kinds. And I've read a little bit about how some kinds are very genetically linked - if your mother or if your mother and grandmother and sister had breast cancer - but other ones, I suppose, are not quite as clearly tracked.

Dr. WALKS: I think that overall, there is a - what you're raising is the whole health education piece. For example, a large part of that is men that have breast cancer. So there's a lot of information that folks need to get, and it goes back to, do you have a relationship with a primary-care doc - whether that's your OB-GYN or whether that's a family-practice doc - who can take a good medical history and let you know what may put you at higher risk genetically, let you know what may put you at higher risk culturally and socially. For example, African-American women tend to have some risk factors that are culturally based. Obesity is one of the huge problems within the African-American community, and it's also one of the huge risk factors with respect to breast cancer.

CHIDEYA: So researchers seem to think that getting an appointment could be tougher than it once was. There's all sorts of issues with managed care and with how many people have good insurance. Is that a factor, in your opinion?

Dr. WALKS: Well, absolutely, it is. And another issue is once you do have an abnormal mammogram then you have other factors that come into play, and this is particularly true for African-American women. And it doesn't seem to relate to whether you're highly educated and have a high income or not. There is the whole worry about they've told me this is abnormal.

My follow up maybe difficult to get. It may take me awhile to get the follow up. And so the follow up just doesn't happen. I don't want to deal with the issue of maybe losing my breast, so I'm not going to go. And so it's not only getting the initial mammogram, but when there's an abnormal mammogram, the follow up tends to be a problem.

CHIDEYA: So when did people first start dealing with breast cancer more openly? Recently, there have been so many campaigns. There's, you know, the Pink Ribbon campaign, Susan Komen, all these walks and 5Ks and things like that. Is - I guess, put it in a context, because is this a question also of awareness or people just kind of being sick of hearing messaging about breast cancer?

Dr. WALKS: Well, I think if you go back - actually, just right about 20 years, back in 1987 when the use of the x-ray or the mammogram to help screen for breast cancer began to become more and more prominent, folks have - breast cancer is a huge, huge killer. And one of the things that's important for us to mention is that even though African-American women may be less likely to develop breast cancer, African-American women are up to twice as likely to die once they do get breast cancer, and it has to do with not having the cancer diagnosed early.

With any kind of cancer, early, early, early is really the word. If you can get screening done and get detection done early. So if you go back over those 20 years, you've had a lot more awareness. Now you have a tool, the mammogram, to begin to get at the screening. And folks, all of the things you mentioned, how people become more aware of it, all of that is out there. But now you have certain things that have began to show we're becoming complacent.

Those of us who need to get the screening done, those of us who are the health professionals and need to encourage folks to get the screening done. And also the folks who make the resources available, whether it's through a managed care or it's through some sort of a public screening program - we know that it's not as easy for folks to get their screening done. That is where I think we need to focus. If you're telling me I should get screened, make it easy for me to get the screening the done.

CHIDEYA: We recently had on the man who was the first black senator since reconstruction - or after reconstruction - 80 years old, living in Massachusetts where he served. And he talked about his fight with breast cancer with Tony Cox. And you mentioned that men are a part of this, it's that breast cancer is not just a female thing. Are men less likely to seek help? Are men less likely to get help?

Dr. WALKS: Well, men are - we're just bad, anyway. Men are less likely to go to the doctor to seek help, to follow up. We just - and there are a lot efforts to get men into the doctor by using women who love those men, by using children who love those fathers or who love those providers and those caregivers. So clearly, there is a whole men's health issue that needs to be addressed.

Breast cancer - if you can think about it this way. If African-American women have an issue with breast cancer and how it may potentially stigmatize them culturally, that's many folds greater for African-American men. So it does need to be publicized, and men need to know that this is something that can kill men. And so men need to get screened early. Men need to look it if they have some increased risk factor - for example, if they had a previous issue with breast cancer. And we need to get - we just need to do better. Men need to do better.

CHIDEYA: We only have minute left, but do you have any last thoughts about what people should do to protect themselves?

Dr. WALKS: I think that if you are a woman over 40, you should get your mammogram. You should understand about what risk factors are unique to you, to your history, to your family history, to your genetic history. And I think a regular visit with your doctor, having someone who is there for you as your primary care provider - again, it could be a family practice doc. It could be a OB-GYN - whoever is going to be there routinely to help see you through your health issues is the one that needs to work with you through this one as well. Breast cancer is preventable. It's treatable. There's no good reason for black women in particular to be less likely to get it and more likely to die from it.

CHIDEYA: Well, Dr. Walks, words to the wise - thanks so much.

Dr. WALKS: Thank you. It's always good to be with you.

CHIDEYA: So Dr. Ivan Walks is former chief health officer for the District of Columbia, and he's NEWS & NOTES resident medical expert. He joined us from NPR's Washington, D.C. headquarters.

And coming up next: the Department of Justice talks diversity, and singer Michael Franti does the "Jail House Rock".

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