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Advocates Look Beyond Early Detection

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For all of the progress and accomplishments over the last two decades, Fran Visco of the National Breast Cancer Coalition is worried. She worries that too few supporters are moved to activism. She worries that the increasingly high profile of the awareness effort has oversimplified a complex disease.

It is much more out in the open,'' said Visco of the disease that kills an estimated 40,000 women each year.Everyone is aware of breast cancer. To some extent, we're victims of that success, because the more awareness you raise, the more you make it palatable. Breast cancer is not a palatable disease.''

In a 2002 poll, the coalition, which represents more than 600 groups, found 32 percent of respondents had worn a pink ribbon as a symbol of support. Only 6 percent had called an elected official to push for federally funded research. Seventy-nine percent agreed that progress has been made in the fight against breast cancer.

There have been bright spots. Tumors found at earlier stages and better treatment methods are credited with lowering the mortality rate. Between 1990 and 2000, the mortality rate decreased 2.3 percent per year, according to the American Cancer Society.

Advocacy groups have been instrumental in pushing the message of early detection. While early detection is an important tool, the subtleties of science are sometimes lost in the message.

A year ago, a large-scale study by the Fred Hutchinson Cancer Research Center in Seattle weakened the case for monthly breast self-examination, finding the practice does not reduce mortality. Soon after, the American Cancer Society made the monthly self-exam optional in its guidelines. The role of annual breast exams performed by a doctor also is being reconsidered, according to Dr. Christy Russell, a spokesperson for the American Cancer Society and co-director of the Lee Breast Center at the USC-Norris Comprehensive Cancer Center.

Mammography, considered the gold standard of early detection, is not foolproof either. The scientific community has engaged in considerable debate over its effectiveness, particularly for women between the ages of 40 and 50. In their guidelines, the National Cancer Institute and the American Cancer Society decided to go with the screenings starting at age 40.

Susan Braun, president and CEO of the Susan G. Komen Foundation, said the brochures and informational materials that are distributed through corporate partnerships and events underscore the sober reality of the disease. Her organization works to balance the grim statistics and the hope that has come with progress, she said.

People don't like to be reminded of things that are difficult,'' Braun said.This is a major killer of women in their middle years.''

Far more work needs to be done, advocates say. Besides encouraging women to get mammograms, those who are diagnosed with breast cancer must have access to treatment, Visco said. The coalition also is pushing for more funding for the National Institute of Environmental Health Sciences to study links between the environment and breast cancer.

It's difficult, complex work that needs to be done to end the disease for all women,'' Visco said.We need to think beyond symbols and awareness to action.''


(The Los Angeles Daily News web site is at )

c. 2003 Los Angeles Daily News

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