Pictures of Health

Though it looks like an overcrowded kitchen bulletin board, it is, in fact, a complex family triage system, the kind you’ll find in many homes with minivans parked at the curb. Life-saving phone numbers (police, poison control, pizza places that deliver in thirty minutes or less) are arrayed across the top. Immunization records, reminders of which kid is allergic to what medicine, and receipts for a flexible spending account are arranged below. The priority position in the middle is given to the yellow forms warning of the latest scourges at school—norovirus, strep throat, head lice. Buried beneath all of it are the items that don’t seem as urgent: my husband’s new eyeglass prescription, a six-month reminder for a dental checkup now six weeks overdue—and a note about the mammogram I was supposed to schedule the moment I turned forty, but haven’t.

It’s not that I’ve forgotten about the mammogram. In truth, I’ve thought about the brochure on breast cancer screening and the accompanying referral form nearly every day since my trusted nurse practitioner pressed them into my hand five months ago. At first, I put the screening off because I’d been told to wait six months after breastfeeding so the radiologist could get a clear reading. When that date came and went, I told myself I was waiting for a free afternoon and a good babysitter—a rare harmonic convergence that seemed better suited to a haircut instead.

When I start to feel guilty about putting it off, I tell myself that plenty of other women can’t find time for their exams either. A study conducted for the American College of Obstetricians and Gynecologists found that about one out of three women hadn’t seen their health care provider on a regular basis or gotten a Pap smear or mammogram during the previous year. That puts me in pretty good company—though not the company I know I should be in.

After all, I’ve raced for the cure, written checks for cancer research, and received my share of worried calls from friends awaiting biopsy results. I know full well that not having a family history of breast cancer doesn’t guarantee I won’t get it. Actually, about 80 percent of the women who have been diagnosed with breast cancer have no known family history of the disease. And while exercising regularly, eating right, and nursing my kids may help reduce my risk, I know that an estimated 3,000 women in Minnesota will find out they have breast cancer this year—though many of them have done “everything right” too. Research hasn’t uncovered all the causes of breast cancer or the cure, but it has shown that regular mammograms can cut your risk of dying from the disease by 30 to 40 percent.

Still, my mammogram referral form remains pinned to the kitchen bulletin board. Maybe it’s time to pin down what exactly is keeping me from making that appointment before another five months go by.

Researchers are asking similar questions in the wake of recent National Cancer Institute findings that fewer women are getting screening mammograms, which are recommended annually for women over forty. Between 1987 and 2000, the mammogram rate jumped from 39 to 70 percent for American women over forty. Then, in 2005, the rate declined by 4 percent across all age groups and by 7 percent among women aged fifty to sixty-four—the group with the most breast cancer cases and those most likely to benefit from a screening.

“It was a big flag that made us ask what’s going on,” says Amy Stella, an oncologist who specializes in breast cancer at the Humphrey Cancer Center at North Memorial Medical Center in Robbinsdale. While lack of health insurance and rising copays have been blamed for some of the decrease, a closer look at the findings reveals that women fifty to sixty-four tend to be the group most likely to have health insurance and access to physicians. “Is [the decline] a trend or is it just a blip?” asks Stella. “I don’t think anyone knows the answer yet, but it’s troubling.”