Like most women in my demographic, I take my health seriously. In addition to annual physicals and bi-annual dental exams, I always schedule a yearly mammogram. While no one in my family has a history of breast cancer, I do it religiously. The statistics are on my side: When breast cancer is detected early, and is in the localized stage, the 5-year relative survival rate is 100%.
But don’t be fooled. Breast cancer is serious business. One in eight women will develop invasive breast cancer, 85% of the cases diagnosed occur in women with no family history, and more than 47,000 women will die from it in 2019. It is the second most deadly cancer for women behind lung cancer in the U.S. But in Utah, it is the primary cause of cancer death for women.
So if there’s 100% 5-year survival rate with early detection, how can it be the number one killer? The reason is not enough women in the state are getting mammograms, which are the best method for finding breast cancer in its early stages. Our research at the Utah Women & Leadership Project found Utah among the five lowest states for mammography screening rates, with only 64.5% of Utah women age 40 and older having had a mammogram within the two previous years, compared with 72.3% of U.S. women.
Let’s examine some of the factors that contribute to this problem. First, there is confusion about how often and when to start screening. The U.S. Preventative Services Task Force recommends screening every other year for women 50 and older. The American Cancer Society, on the other hand, recommends that women should be screened annually starting at 45. When the medical societies are dueling over recommendations, it’s easy to be confused about best practices.
Another factor is income. Women without regular primary care or without health insurance coverage had a large proportion of nonadherence. For most of us, our doctors tell us it’s that time again and start the process of arranging a mammogram. If I need to cancel, you can be sure I’ll get a call asking me to reschedule. And my insurance covers it so cost isn’t an issue. For me, it’s sometimes harder to avoid a mammogram than it is to simply comply. But not everyone has my privilege. Thankfully, Utah has programs in place to help women get screened regardless of income or insurance status.
The group that had the highest level of non-compliance was women with three or more children still at home. Given that Utah has a larger family size and higher birth rate than the rest of the nation, this is not a small group. This larger family size may contribute to women feeling they do not have time to seek out mammograms, and indeed women often cited “lack of time” as a significant factor in their failure to get a mammogram (18% of women gave this reason, second only to “cost/not covered by insurance,” given by 20% of the women surveyed).
Like most of you, I’ve known many women who had breast cancer. Thanks to early detection, the majority are still here to tell their stories. But one dear friend is not, despite aggressive chemo and other treatments. I will always remember sitting by her hospital bed during her last days. She often asked me to bring my guitar and sing to her. Mostly I just held her hand so she knew she was not alone.
While mammograms may not prevent breast cancer, they are a woman’s best chance of early detection and long-term survival. Cancer kills. Even cancers represented by pretty pink ribbons.
Dr. Susan R. Madsen is the Orin R. Woodbury Professor of Leadership & Ethics in the Woodbury School of Business at Utah Valley University and the founding director of the Utah Women & Leadership Project.