Breast Cancer Drop May Just Mean Fewer Detected Cases

Dec. 15, 2006— -- Researchers have broached another possibility today to account for the decline in breast cancer rates, and it's not good news.

A day after the announcement of research citing the drop in women undergoing hormone replacement therapy as the chief reason for a steep drop in breast cancer cases, some experts suggest that just as many women may have breast cancer, they just aren't getting screened for it.

"We have been aware for several years that the number of radiologists who specialize in mammography have been decreasing, and that there are places in the United States where women have difficulty getting access to mammography," writes Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, in a blog released after the announcement on the society's Web site.

"If mammography use has reached a peak and is now decreasing, we may actually be diagnosing fewer cancers when they can be most effectively treated. If you don't get a mammogram, you don't diagnose a cancer."

Dr. Michelle Warren, medical director of Columbia University's Center for Menopause, Hormonal Disorders, and Women's Health, calls the current availability of mammography in the United States "a crisis."

"The reimbursement for mammography has sunk so low and the risk is so great -- the most common malpractice suit is failure to diagnose breast cancer -- that centers have either stopped doing them or do so few that there is a three- to six-month wait," she says.

"I have a patient I saw yesterday who just made an appointment for the end of April. So declining mammography may well be contributing."

The research linking the decline in HRT to the drop in breast cancer came from the M.D. Anderson Cancer Center in Houston and was discussed at a breast cancer conference in San Antonio Thursday. It was based on a recent report by the National Cancer Institute that showed a 7 percent drop in new cases of breast cancer between July 2002 and August 2003.

The drop corresponds with the results of the 2002 Women's Health Initiative study, which suggests the link between HRT and breast cancer. Millions of women quit HRT after the news.