MAMMOGRAMS: MAKING TIME FOR LIFE

The 39-year-old school teacher walked briskly into the Womancare center at St. Francis Medical Center a few minutes before 4 p.m. Thirty minutes later, the mammogram completed, Martha Nothdurft was ready for the drive home.

Yet, Nothdurft believes, the ramifications of such a half hour could save her life.

She doesn't shy from talking about her commitment to carefully caring for her health. Nothdurft's been told some hard facts.

"I have a 30 percent chance of developing breast cancer in the next 40 years, and that increases until I turn 65," Nothdruft said. Confronted with a family history of breast cancer, she and her three sisters are united in their determination to fight the disease. "All of us are kind of particular about getting regular check-ups," she said.

Her commitment is such that more women should adopt, even if they have no family history of breast cancer, many health providers say.

The American Cancer Society recommends that women obtain their first mammogram, called a baseline mammogram, between the ages of 35 and 40. That first mammogram is used for comparative purposes as the woman matures.

Helping women become more educated about their bodies and more comfortable with measures they should take in caring for themselves are main goals of Womancare, established at St. Francis Medical Center in 1985. Womancare adheres to the mammography guidelines set forth by the American Cancer Society. At Womancare, a woman aged 35 and over can make her own appointment for a mammogram.

"Women need to be more active in deciding what is good health care for them, and identify those things that are in their best interest," said Barbara Crowell, patient care manager of Womancare. The center contends that mammography and regular breast self examination are invaluable tools in maintaining good health.

"I know my chances of finding it, if it is there, are increased with this," Nothdurft said shortly after her mammogram. "You go by other healthy rules, this is just one more for women," she said. "It's one more thing you can do to make sure you're as healthy as you can be."

Costs, lack of time and the "it can't happen to me, I don't need one," attitude are some of the excuses women manufacture to talk themselves out of seeking mammograms, said Susan Farrow, cancer center nurse at Southeast Missouri Hospital.

Mammograms are performed at both Cape Girardeau hospitals and at Cape Radiology.

There are two types of mammograms: screening and diagnostic. The screening version is for women who have no symptoms of breast cancer, while the diagnostic mammogram can be used to help evaluate abnormalities of the breast.

While old habits are slowly changing and women are becoming more attuned to caring for their bodies, the number of women performing monthly breast self examinations and following the recommended American Cancer Society guidelines for mammograms falls short.

"More and more physicians are encouraging their patients to have mammograms as suggested by the American Cancer Society guidelines," Crowell said. Nevertheless, she noted, "There's still a lot of complacency and certainly a lot of confusion as to what those guidelines are."

The society, along with approximately a dozen other nationally recognized organizations, adopted recommended mammography guidelines several years ago. Review and modification followed as technology matured.

Those groups in agreement with the American Cancer Society guidelines include approximately a dozen highly respected organizations including the American Academy of Family Physicians and the American Medical Association, the Womancare manager said.

Those guidelines -- for women who are not at high risk for breast cancer or who do not have symptoms -- stipulate that women between the ages of 40 and 49 should have a mammogram every one to two years. Women aged 50 and over, the American Cancer Society recommends, should have a mammogram every year.

"It's generally felt that 50 percent of all people who die of breast cancer could be saved if all women followed the accepted guidelines," Crowell said, "because breast cancer is highly curable if it's found in the early stages."

And that's just what mammography is designed to do.

While not foolproof, a mammogram can frequently detect breast cancer years before it can be felt by hand or found by other methods of diagnosis, health professionals say.

The x-ray -- which is the mammogram -- is a relatively painless procedure for most women.

"This doesn't really hurt, it's just kind of uncomfortable," Nothdurft explained as registered technologist Padge Haman adjusted the machine which allows the individual to stand upright throughout the brief x-ray process.

"The size of the breast makes no difference in the comfort level," Haman explained, but rather, the sensitivity of the breast determines the amount of discomfort a woman may experience. Temporary soreness may follow a mammogram.

Radiation risks are minute, Crowell explained. "It's such a small amount of radiation because of the compression that they use and because of the low amount of radiation that is used that it's not a concern." Stringent regulations regarding the professionals performing the mammograms and the machinery are administered through the Missouri Department of Health.

Nothdurft asserted that the potential benefits of a mammogram far outweigh the time, cost, discomfort, or even fear, that may accompany the process.

Some estimates are that approximately one woman out of nine will develop breast cancer at some time in her life. Family history can put a woman at even greater risk. It's a subject with which Nothdurft and her family are intimately acquainted.

Her mother died of breast cancer about 13 years ago. In January, one of her three sisters was diagnosed with breast cancer. Since then, that sister has undergone a mastectomy and is receiving chemotherapy, Nothdurft said.

Nothdurft and two of her sisters have been accepted into a national study called Breast Cancer Prevention Trial. The trial will study whether the medication tamoxifen may prevent breast cancer from developing in women who are at increased risk.

Both St. Francis Medical Center and Southeast Missouri Hospital are participating in the research project.

While Nothdurft and her family are experiencing trauma and anxiety far exceeding what most have to face, no woman should feel immune from the possibility of cancer.

The majority of breast lumps are benign, or noncancerous. However, any abnormality should be reported to a physician immediately.

With early detection, approximately 95 percent of breast cancers are curable, Crowell stressed.

"Even though there's different kinds, with different degrees of severity, it's just a scary thing," Nothdurft said of the disease.

"You could live the rest of your life and be scared to death," she said, or "you can give it your best shot and then you know you've done everything you can do."

She warns against complacency that is bred by no known cancer occurrences within a family. Crowell agrees. "Eighty percent of all detected breast cancers are in women who do not fall into a high risk category other than the fact that they are women," she said.

After all, Nothdurft said, "In every family, someone's got to be the first one."