Center studies breast cancer trend in Latinas

By NATALIA LOPERA, Arizona Daily Star

TUCSON, Dec. 23, 2009 (AP): Josefina Iturralde was told she was too young to get a mammogram when she was 38, even though she had pain in her left breast.

For decades up until a few weeks ago, the standard was for women to get their first mammogram when they turn 40.

But for Iturralde, now 43, it was a huge mistake to follow her doctor's recommendation.

It turned out to be cancer, but she didn't get diagnosed until two years later.

Today, Iturralde is worried for other women, because a group of independent doctors and scientists has recommended that the majority of women should wait until age 50 to get their first mammogram.

From then on, the group recommends a mammogram every other year. It also said the breast self-exam shouldn't be taught because it doesn't work.

``If my doctor would have listened to me, my prognosis would have been better,'' Iturralde said as a nurse prepared her for her weekly chemotherapy at the Arizona Cancer Center.

She ended up losing both breasts, and when it appeared that her cancer was gone and she was going to get reconstructive surgery, she was told that it had spread to her liver.

``If I had gotten a mammogram, maybe my cancer would not have metastasized. Maybe I wouldn't have had to lose my breasts,'' she said.

Latinas in the United States are getting more aggressive forms of breast cancer, according to a study at the Arizona Cancer Center.

They also are getting breast cancer at an earlier age. On average, Latinas are getting it in their late 40s or early 50s, while non-Latina women get it in their 60s, said Elena Martínez, principal investigator and co-director of the cancer prevention and control program at the Arizona Cancer Center.

``The question is: If Hispanic women are getting cancer earlier, i.e., before their 50s, is this (the recommendations) going to be worse for them?'' she said. ``We don't have the answer yet.''

The Arizona Cancer Center study found that the majority of women under scrutiny found their cancers through self-exams, not by mammograms. And even after finding something abnormal in their breasts, they still waited before seeking care.

Martínez also said that women who speak only Spanish have lower rates of seeking mammography. She said she doesn't know if the new recommendations will discourage Latinas even more.

``(It) may increase awareness and make them question things and maybe get screened at higher rates,'' she said. ``Or they may think: 'See? They don't know what they're doing. They can't get it right.' I don't know which way it's going to go.''

But others—such as Dr. Ana María López, who also is at the Arizona Cancer Center—say women shouldn't be alarmed because the recommendations are designed for a specific group of women.

López, who also teaches medicine and pathology at the University of Arizona and is associate dean at the College of Medicine, said the recommendations are meant for women who have a normal risk and have no symptoms.

``If you are not high-risk and you have no symptoms, then this may apply to you,'' she said. ``But to figure that out, you need to talk to your doctor.''

She noted that it would not apply to someone like Iturralde who had pain, because that is a symptom.

Evidence shows it's more common for mammograms done on women who are 40 to 49 to result in false positives, according to the U.S. Preventive Services Task Force, the group that made the recommendations.

The task force said mammograms cause ``psychological harms'' and that false alarms are followed by unnecessary biopsies. It also said that mammograms don't really reduce the number of deaths from breast cancer within this age group.

``We need better tests; the mammogram is the best one we have. We need something better, especially for younger women,'' Lopez said.

The task force also said that self-breast exams really do no good.

``That's not new,'' López said. ``We do not have evidence that it reduces mortality from breast cancer.''

Martínez explained that by the time a woman feels a lump on her breast, the cancer is at an advanced stage.

But Martínez and López both agree that it is of value, because a lump serves as a red flag, and a woman can then go to her doctor once she finds an abnormality.

It was through a self-breast exam that Iturralde knew she needed help.

She said her doctor initially thought her pain was due to a muscle spasm. He later attributed it to her large breast size and even recommended that she get a breast reduction.

But over time, Iturralde developed a small lump that looked like a ``mosquito bite,'' and it began to grow. That was when she decided to switch doctors, and her cancer was diagnosed.

``Listen to your body and your instincts; they tell you the truth,'' she said. ``If your doctor is not listening to you, then he is not a good doctor. Find someone else.''

Information from: Arizona Daily Star, http://www.azstarnet.com