The slogan was to the point: "Mammography costs about $60. Think what you could save."
It was part of a bold publicity campaign planned by Utah's Breast Cancer Task Force to help encourage women to receive mammograms - a breast X-ray - the only test that will detect cancer early enough to prevent death.Along with the slogan, the campaign included a billboard bearing a photograph of a woman with hands covering her breasts. All tastefully done, of course.
But male designers nixed the idea, saying that viewers might think it too suggestive. While the slogan stayed, the photograph was cropped below the neck. The end result made it look, says Ladene Larsen of the state health department, as if mammography is a neck X-ray.
Members of the Utah House of Representatives Health Committee were also squeamish about the topic. They suggested editing the word "breast" out of the title of HB230, a bill concerning breast-cancer screening, on the grounds that a bill bearing the name of the procedure, mammography, would be less controversial.
Why the sensitivity? Simply put, a breast is not just another body part. Breasts are the most distinctive curve of the female anatomy. Cleavage is used to sell everything from diet drinks to cars, from lusty romance novels to Sports Illustrated magazine.
That breasts are perceived sexually is nothing new. But now they're becoming political as well.
And society's preoccupation with breasts - the perception of the chest as a sex symbol instead of a body part requiring health care - is killing women.
"Breasts are an aspect of a women's sexuality," said Dr. Irena Tocino, "but they are also a part of a woman's body that can get sick just like any other organ. We need to look at it as when you have a bad cough, you need to take care of it. When you have a lump (in a breast), you have to take care of it. We have to treat them with the same respect as any other organ.
"We are not making any progress," said Tocino, who is chief of mammography radiology at LDS Hospital and head of the Utah Breast Cancer Task Force. "The same number of women today are dying of breast cancer as in the 1930s."
One in nine women gets breast cancer
Nationally, the disease will claim about 44,500 women this year, according to the American Cancer Society.
Researchers have determined that other cancer mortality rates can be reduced through lifestyle changes. For instance, smokers can stop smoking to reduce the likelihood of contracting lung cancer. While some preliminary research suggests that breast cancer is related to a high fat diet, it is still, for the most part, a disease that targets, quite simply, women.
In the speeches that Tocino gives about the need for mammography, she uses a slide to illustrate a chilling fact: "One in 10 women will get breast cancer." In 1960, that statistic was only about one in 20.
But two months after she prepared that slide, the fact was already outdated. In January, the American Cancer Society released new numbers. Now statistics predict one in nine women will get breast cancer.
No one knows why more women are getting breast cancer. Some of the rising incidence can be blamed on the aging population of baby boomers. Maybe increased screening and better detection folds into the numbers, too. Diet and delayed childbearing might be factors in breast-cancer incidence, but experts aren't sure.
"Every woman should consider herself at risk," according to Dr. Clark Heath, vice president of epidemiology and statistics for the American Cancer Society, who urges monthly self-examinations and regular clinical examinations for younger women.
An `embarrassing' disease
Breast cancer used to be considered anembarassing disease because it involved body parts so integral to a woman's sexuality. Women as well as men protected the erotic nature of breasts.
In the past, discovering breast cancer usually meant a mastectomy, surgery that often carved into a woman's sexuality as well as her breast tissue. Some women carried emotional fears of disfigurement, a cancer that left scars as deep as any surgery.
For a time, the medical community worried that mammography itself caused cancer. But now it believes the small amount of radiation that occurs during a breast X-ray isn't carcinogenic.
And with early detection of breast cancer, mastectomy isn't an automatic procedure. Treatments can halt the growth of some cancers.
But many health experts believe some women are so afraid of losing their breasts, and a part of their sexual identity, that they won't schedule the test.
"I think about breast cancer because my mother died of breast cancer, and I'm in the high-risk group," said Dr. Suzanne Dandoy, executive director of the Utah Department of Health. "The average woman doesn't want to face the risk. She says, `I'm the other eight.' "
"Until we know how to prevent breast cancer, we should be doing everything we can to make sure women are getting early detection services," said Larsen, who directs the state's Bureau of Chronic Disease Control. "Not only do you save your life if you detect breast cancer early, but you can save your breast."
A `women's issue'
Attention to the disease is growing. But for decades, breast cancer has been a disease that, like many concerns tagged "women's issues," remains outside the mainstream of the country's political agenda.
Women are regularly excluded from government-funded medical research tests, according to Mary Lake Polan, chairwoman of the Department of Gynecology and Obstetrics at Stanford University School of Medicine.
Polan, in an article for the Los Angeles Times, suggests that front-page headlines should focus on increased funding for breast-cancer research and treatment breakthroughs rather than the increased odds of getting the disease.
She contrasts the dollars invested in AIDS research with those invested in breast-cancer research. Since 1980, about 54,000 people have died of AIDS. About eight times that many women have died in the same time period of breast cancer. Yet 44 times as much money was spent by the National Institutes of Health on AIDS research, while most of the early AIDS drug trials excluded women and children.
A telling comparison in Utah is that of educational and prevention programs.
For example, in 1988, 40 people in Utah died of AIDS. In that same year, more than four times that number of Utah women - 177 - died of breast cancer, despite the reliability of mammograms for early detection. (To put that statistic into focus, about 25 Utah men died in 1988 of prostate cancer, a men's disease.)
Nonetheless, the state allocated $324,900 last year for AIDS prevention, education, screening and counseling programs and managed federal funds of $1.18 million. The state allocated less money, $292,900, for two cancer screening programs, tests for breast and cervical cancers, and received no federal funds. Any education about breast cancer provided by the state came about through those screening programs.
AIDS is a virus that some predict could spread to epidemic proportions. But some medical experts would argue that breast cancer has already killed an epidemic number of women.
Dr. John Nelson, a Salt Lake gynecologist, thinks the comparison is valid.
Like others, Nelson doesn't think funds should be siphoned away from AIDS research. But he thinks the contrast underscores how lack of political noise has kept breast cancer a silent killer of women.
Those in the high risk group for AIDS can alter their lifestyles and reduce their chances of getting the disease, which is spread mostly through sexual activity with an infected person especially in the homosexual population. But women can't make lifestyle choices to reduce their risk of breast cancer. The medical knowledge about risk factors remains vague at best.
That's why mammography, which translates to early detection in time to lower the risk of death, means so much. That's also why Utah advocates speak so strongly about the need for more stringent regulations of mammography equipment.
"The big issue is that despite all of our advances, if breast cancer has spread to other areas of the body, then we cannot cure it," said Dr. John H. Ward, an associate professor at the University of Utah Medical School. Ward is part of a team of researchers studying the genetics of breast cancer.
An ounce of prevention
And speaking of prevention, there's no better example of how cancer can be battled through early detection than that of Pap smears. After the test became part of a woman's routine physical examination, the mortality rate of cervical cancer declined 70 percent to 80 percent in the United States.
The medical community hopes to see such a dramatic decline in the death rate of breast-cancer victims, too, when mammography becomes routine.
To prevent a breast-cancer epidemic, women need to become more vocal, health experts say. They should demand more money to research the cause of the disease, more insurance money for tests, more information about risks.
"Women need to be saying: `There is a test. I want to have it at a reasonable cost, and I want to have it in a safe facility,' " Larsen said.
"I think women just need to be more knowledgeable and more savvy consumers. I would be saying to myself: `If my doctor isn't recommending that I get a mammogram, then why not?' "
(See microfilm for complete obituary.)
Breast cancer strikes one in nine women.
In the past 30 years, as Pap smears have become a routine part of a woman's physical examination, mortality of cervical cancer has declined 70 percent to 80 percent.