Breast cancer is a terrible disease. It is the most frequently diagnosed cancer among women and the second leading cause of cancer death for women in the U.S. More than 190,000 women in the U.S. will be diagnosed with breast cancer this year, and more than 40,000 will die.
Early detection is a key to surviving the disease: When breast cancer is detected early, the 5-year relative survival rate is 98 percent, but declines to 84 percent for regional disease and 23 percent when cancer has spread to other parts of the body. Unfortunately, we see racial, ethnic, geographic and socio-economic disparities in access to breast health care, which in turn leads to disparities in survival rates.
Fully one-third of women in the U.S. today — some 23 million women — are already not receiving regular recommended screening due to lack of access, education or awareness. This is especially concerning in light of the confusion generated by the new screening guidelines announced by the U.S. Preventive Services Task Force last year. Regardless of their intent, the Task Force recommendations, combined with budget cuts to NBCCEDP screening programs at the state level, give the mistaken impression that cancer screening is not important.
Women Age 40 to 49
In November, the U.S. Preventive Services Task Force released the following new guidelines for screening mammography:
- For women ages 40-49, the guidelines for screening mammography changed from a B rating (recommended) to a C rating;
- For women ages 50-74, the guidelines for screening mammography remains a B (recommended), but the recommended frequency changed from “every 1-2 years” to biennial (every other year);
- For women ages 75 and over, the guidelines for screening mammography changed from a B (recommended) to an I (insufficient evidence);
- The guideline for teaching regular breast self-examination (BSE) changed from an I (insufficient evidence) to a D (not recommended); and
- A guideline was added, rating digital mammography and magnetic resonance imaging (MRI) over film mammography as an I (insufficient evidence).
These changes have again reignited the controversy over mammography screening, a debate that has raged for a number of years. It is important to remember the following:
- While there is some disagreement about when mammograms should begin and on what schedule, all agree — including the USPSTF — that mammograms save lives in women 40 to 49, as well as women over 50.
- Susan G. Komen for the Cure continues to recommend annual mammography beginning at age 40 for women of average risk and earlier for women with known risks for breast cancer. We are constantly evaluating our guidelines and would not change them without serious consideration.
- Our real focus, however, should be on the fact that one-third of the women who qualify for screening under today’s guidelines are not being screened due to lack of access, education or awareness. That issue needs focus and attention: if we can make progress with screening in vulnerable populations, we could make more progress in the fight against breast cancer.
For more on Komen’s position on screening for women age 40 to 49, click here to see Congressional Testimony delivered by Komen Advocacy Alliance President Jennifer Luray in December 2009.
Breast Cancer EARLY Act
The EARLY Act was originally introduced in March 2009, by Reps. Debbie Wasserman Schultz (D-FL), Sue Myrick (R-NC), Donna Christensen (D-VI) and Rosa DeLauro (D-CT) introduced the Breast Cancer EARLY Act (Education and Awareness Requires Learning Young) in the U.S. House (H.R. 1740). Senators Amy Klobuchar (D-MN) and Olympia Snowe (R-ME) introduced a similar bill in the U.S. Senate (S. 994). The EARLY Act would:
- Initiate an evidence-based public education campaign about breast cancer in women under age 45 — with an emphasis on women at higher risk due to their race, ethnicity or genetic heritage.
- Educate health care professionals about the risk factors, opportunities for genetic counseling and testing, and unique challenges that face young women diagnosed with breast cancer.
- Provide grants to organizations that provide credible health information directed to young women diagnosed with breast cancer.
The EARLY Act was inserted into the health reform bill, and became law with the passage of the health reform bill in March 2010. The Centers for Disease Control and Prevention is charged with overseeing the EARLY Act program, and the Komen Advocacy Alliance will be monitoring CDC to see that the program is properly implemented.
Why is the EARLY Act Needed?
- While it is rare, young women under age 45 can and do develop breast cancer. In the U.S. about 10 percent of all breast cancer occurs in women under age 45:
- 24,000 women in the U.S. under age 45 are expected to be diagnosed with breast cancer this year (including situ breast cancer), and more than 3,000 will die.
- Breast cancer is the leading cause of cancer deaths in women under age 40.
- The five-year relative survival rate in the U.S. is slightly lower among women diagnosed with breast cancer before age 40 (82 percent) compared to women diagnosed at ages 40 and older (89 percent).
- Diagnosing breast cancer in young women can be more difficult because their breast tissue is often more dense than the breast tissue of older women. By the time a lump can be felt in a young woman, it is often large enough and advanced enough to lower her chances of survival. In addition, the cancer may be more aggressive and less responsive to hormone therapies.
- There are benefits to starting evidence-based, age-appropriate breast health education early. By starting young, when women are still developing their lifelong habits, educating them about the benefits of healthy living and breast self-awareness will lead to a lifetime of empowerment. And they may be willing to adopt healthy lifestyles including exercise and nutrition.
Komen has a long history of working with younger women who are affected by breast cancer and provides educational materials and resources for younger women diagnosed with breast cancer. Komen strongly encourages every woman to take charge of her life. First, know your risk — learn your family health history and talk to your provider about your personal risk of breast cancer. Second, get screened — ask your health provider which screening tests are right for you. Third, know what is normal for you — know your body and tell your health provider right away if you notice a change in the way your breasts look or feel. Finally, make healthy lifestyle choices. More information is available on www.komen.org.
Read a one-page overview of the Breast Cancer EARLY Act
Read a joint statement on the EARLY Act