There may be another explanation for the recently announced decline in breast cancer rates. And it's not nearly as promising as the first explanation may be.

A day after researchers announced that the significant drop in breast cancer cases is primarily due to fewer women using hormone replacement therapy (HRT), some experts suggest breast cancer rates are not dropping at all. Just as many women may have breast cancer, they say. They just aren't being screened for it.

"We have been aware for several years that the number of radiologists who specialize in mammography have been decreasing, and that there are places in the United States where women have difficulty getting access to mammography," Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, wrote on the society's blog just after the public announcement.

"If mammography use has reached a peak and is now decreasing, we may actually be diagnosing fewer cancers when they can be most effectively treated, Lichtenfeld said. "If you don't get a mammogram, you don't diagnose a cancer."

The research linking the decline in HRT to the drop in breast cancer came from the M.D. Anderson Cancer Center in Houston and was discussed at a breast cancer conference in San Antonio on Thursday. The research, based on a report by the National Cancer Institute, showed a seven percent drop in new breast cancer cases between July 2002 and August 2003, corresponding with the results of a 2002 Women's Health Initiative study.

With media reports citing HRT as the direct cause of the drop, some worry the public is getting the wrong message -- specifically women still taking hormones or those who have taken them in the past. While women not taking hormones are breathing a sigh of relief, others are in a panic.

Dr. Katherine Sherif, director of the Drexel Center for Women's Health at Drexel University College of Medicine in Philadelphia, has spoken already with 15 patients worried about this news.

"What I have told them is that three years is too short of a time to measure the effects of a drug on breast cancer," she said. "Cancers take decades to develop, and conversely, withdrawing hormones could not result in a decrease in breast cancer in three years -- it's actually absurdly short." There are also concerns women will experience anxiety about other therapies using estrogen, such as in vitro fertilization (IVF).

The study on HRT and breast cancer may be raising more questions than answers -- which could be a good thing. More questions prompt more investigation, more study, more research. And this will hopefully help us figure out one facet of the mystery of breast cancer.

Previous posts on the topic of HRT and breast cancer are as follows.

• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

Mammograms are offered at the M.D. Anderson Cancer Center in the Texas Medical Center. They are also offered on M.D. Anderson's self-contained 38-foot van containing a LoRad MIV mammography unit. The van travels to various workplace sites where employees and clients can jump on board the van for a mobile mammogram.

Hartford Hospital's Take the Time mammogram van travels to clinics, churches, senior centers, and other Connecticut locations where women can easily access life-saving screenings. The University Breast Health Center in Augusta, Georgia is home to a mobile mammography program that reaches underserved women unable to report for on-site visits. Lexington Medical Center in South Carolina offers mobile mammograms. Y-ME National Breast Cancer Organization affiliates offer their own traveling screening services. And a mobile mammogram service was offered on Kent State University's campus during this October's Breast Cancer Awareness Month.

Mammograms on the go are no different than mammograms at fixed locations. They are high quality, safe, confidential -- and typically speedier than the traditional screening procedure. Often, a woman knows before she departs that her image is technically accurate. She can ask questions and receive information, and she can expect a prompt call from the radiologist or her physician who will discuss results. Sometimes, mobile mammograms take as little as 20 minutes to complete.

Mammograms are recommended for women age 40 and older and for women with a personal or family history of breast cancer. As with all medical services, there are barriers -- such as awareness, cost, transportation, convenience -- that prevent access for some people. Mobile mammograms help drive away barriers. They allow more women more access to the best tool for identifying breast cancer in its earliest form.

Roll on, mammogram vans!

He an unlikely breast cancer survivor -- because he is a man. But still he developed the disease that roughly 1,700 men will contract this year. And while that statistics pertaining to women and men with breast cancer differ -- women are 100 times more likely to get the disease -- the biology of the disease is exactly the same. Under the microscope, breast cancer is breast cancer. It does not behave any differently in female and male bodies. And detection, treatment, and survival rates are nearly identical for both sexes.

Bob Riter, 49, was diagnosed with breast cancer in 1996. Now in remission, he works as the associate director of the Ithaca Breast Cancer Alliance in New York where he speaks out and educates the public about this widespread disease. He believes his personal story, with its different twist, prompts people to really listen.

Riter's audiences learn that breast cancer in men usually presents itself as a lump in the chest, dimpling of the skin, or changes in the nipple. Doctors can perform breast exams, mammography, and biopsy to investigate the possibility of the cancer that typically strikes men between the ages of 60 and 70. Treatment includes mastectomy to remove the tumor and surrounding lymph nodes, chemotherapy, radiation, and hormone therapy.

It was the presence of blood coming from his nipple that sent Riter to his doctor -- and then to a surgeon who declared a diagnosis of breast cancer. Riter is somewhat of an exception because he reported to his doctor immediately. Most men do not. Many do not even realize they are at risk of breast cancer so they ignore symptoms. They also may go underground with their suspicions of breast cancer because of embarrassment. Both can lead to diagnoses of more advanced diseases.

Riter is doing his part to enlighten both men and women that men are not immune to breast cancer, that they should be active in monitoring their breast health. "I really like to go to national breast cancer meetings," he says, "because a lot of people know that men get breast cancer in theory, but until you have a face to associate with it, it's fairly abstract. And so I'm sort of that face."

My sister recently ran into the surgeon who removed my breast cancer tumor almost two years ago -- on December 3, 2004. He asked my sister how I was doing, recalled the unprecedented rash I developed from the latex and Tegaderm tape used during my lumpectomy, and then talked about how terribly busy he has been.

This surgeon -- who spends countless clinic hours with women whose breasts are somehow diseased and then spends day after day in operating rooms trying to remedy these diseases -- said he is amazed and at how many breast cancer cases are consuming his time. It's sad -- the amount of women showing up with breast cancer -- but there is a silver lining to this cancer cloud, because according to this surgeon, the vast majority of these breast cancer cases are early stage. This means they were caught swiftly and quickly. And for the women behind these cases, there is a good chance of long-term survival.

And so maybe all the pink and all the press surrounding breast cancer is working. Maybe it's inspiring women to pursue self-breast exams, clinical exams, mammography, and other screening options. Maybe all the persistence and passion about breast cancer is the reason for this early detection -- the key to a good prognosis.

My surgeon closed his chat with my sister by telling her to call him if anyone in our family ever needs anything. But he told her he hopes he never has to hear from us. My sentiments exactly.

Technology has come a long way over the years -- and now the technology behind digital mammography is allowing life-saving screenings for the toughest patients to diagnose with breast cancer.

This is no small technological breakthough. It is a critical component for lowering the breast cancer death rate the American Cancer Society reports has declined 2.3 percent each year between 1990 and 2002. Since breast cancer is a treatable disease if caught early, digital mammography will up the odds of survival for women with this disease.

Digital mammography operates according to a computer-based technique that allows for digital manipulation of a breast X-ray. It exceeds the capability of film mammography -- and is much like the comparison between digital photography versus film photography. Both work. But one works better.

Studies show digital mammograms have a lot to offer. They detect tumors better in young women with dense breast tissue, for example. They allow for ease of storage and retrieval of images. And they can easily become part of a woman's electronic medical record.

There are still benefits of traditional mammography and women are still urged to use this less expensive option. They are also urged to conduct self-breast exams and to report for clinical exams with physicians. It's the whole package that contributes to comprehensive breast health, not just one isolated test. When used in combination with all other screening methods, digital mammography makes for a more accurate overall picture.

In an international study involving 500,000 women, researchers concluded for every 2,000 women who had a mammogram, one will have her life prolonged, but ten will undergo unnecessary chemotherapy, radiotherapy and mastectomies. According to Nordic Cochrane Centre researchers, while mammograms do prevent breast cancer death in detecting early-stage breast cancer, it also leads to breast cancer diagnosis in women who would have survived without treatment.

Professor John Toy, medical director of Cancer Research UK, is quoted as saying, "Researchers in the field all agree that breast screening saves lives although they differ in their views about the balance of the pros and cons. Benefits need to be balanced against any disadvantages, as is the case with all medical treatments. Certainly women invited for screening should be made aware of both potential benefits and downsides."

This leaves women in a difficult position. As more women are encouraged to go in for breast cancer screening, more early-stage breast cancer is being discovered. The earlier a cancer is discovered, the better the chances of surviving cancer. That's a given.

However, if they cannot predict how the cancer will behave when found in its earliest stage, or if it will ultimately be life-threatening -- and if, as this study suggests, one woman will be helped while ten women will undergo unnecessary chemotherapy, radiotherapy and mastectomies -- how does a woman decide which treatment or non-treatment path to go down? Chemotherapy, radiotherapy and mastectomies are not simple innocuous treatments.

At this point, I am not certain what we should do with the findings of this study other than be confused, worried and uncertain. What do you think?

Breast cancer is widespread -- so widespread that most of us have direct personal contact with someone living with this disease. Information about breast cancer is also widespread -- so widespread that it's easy to get lost in the maze of details that define this illness that two million women in the United States are living with at this very moment. Breast cancer has its own set of definitions and facts and statistics -- and myths too. And here are seven myths that are not worth spreading.

Most lumps in the breast are cancer.
Actually, most lumps in the breast are not cancer. But every lump should still be examined and diagnosed.

Breast cancer does not occur in young women.
While most breast cancer cases occur in women over the age of 50, breast cancer can and does occur in women of all ages. I was diagnosed at age 34.

Women with large breasts have a greater risk of breast cancer.
Size does not affect risk. But it can be more difficult to examine large breasts and therefore detect a suspicious lump due to a larger amount of tissue.

A woman has little or no risk of breast cancer if she has has no family history of the disease.
Most women with breast cancer -- about 75 percent -- have no family history of breast cancer. Simply being female puts all women at risk. I have no family history of breast cancer -- but I still was diagnosed with this disease and have been treating it for almost two years.

If mammography shows nothing to worry about, then there is nothing to worry about.
Mammography can miss 10 to 15 percent of all breast cancers. So any suspicious mass should be investigated with further tests -- such as ultrasound and MRI. When my lump was examined during a mammogram, my doctor was not worried. But an ultrasound that followed revealed a solid mass -- and this was something to worry about. A biopsy came next. And then came my breast cancer diagnosis.

Once a woman is treated for breast cancer, she should avoid becoming pregnant.
Many breast cancer survivors go on to have successful pregnancies and healthy children. Women should consult their doctors, however, about current and previous treatments and should discuss any possible concerns about pregnancy after breast cancer.

Removal of the entire breast is safer than segmental mastectomy.
Survival is similar for women who have breast-conserving surgery -- like a lumpectomy -- and for those who have either a total or modified mastectomy.

It's not surprising that inaccurate information is floating around about breast cancer -- because there is so much information on the topic and much of it is not completely understood by those who study the disease every day. But we all can take an active part in our own education by researching each tidbit of news that comes our way. We can confirm it, deny it, and understand it better if we take matters into our own hands. And if we don't spread anything we just are not sure about. We owe it to ourselves -- and women everywhere -- to spread only the most accurate information about this disease we all need to better comprehend.

Scientists have announced the development of an ultra-sensitive blood test for breast cancer that can detect breast cancer at its earliest stages and potentially improve breast cancer screening for younger women. Mammography, the standard method in breast cancer screening, is less accurate for younger women.

The blood test is 200–1,000 times more sensitive than existing tests, according to UCL Medicine, University of Pennsylvania, the University of Pittsburgh and BioTraces, Inc. researchers who all worked to develop the test. Pilot studies also indicate the blood test might prove valuable in the screening for prostate cancer, ovarian cancer and melanoma skin cancer.

Currently, breast cancer diagnosis is done by breast examination, imaging with mammography and ultrasound, and then biopsy. The researchers are hoping that the new blood test might eliminate the need for a biopsy in making a final determination of cancer. The report is published in the Journal of Proteome Research.

According to the National Consumers League, don't become a breast cancer statistic. Breast cancer is highly detectable through mammography screening. The earlier it is discovered, the greater a woman's chance for survival. Breast cancer is the second most common cancer in women and the leading cause of cancer-related deaths in women between the age of 40 to 55.

Because of this reality, a brochure -- Mammograms: Consumer Guide to Breast Cancer Detection -- is made available online as a PDF document. The brochure covers breast cancer facts; screening methods, frequently asked questions; reducing your breast cancer risks, and tips to take before mammography screening.

The National Consumers League, founded in 1899, works to identify, protect, represent, and advance the economic and social interests of consumers and workers.

If you have been putting off mammograms because of the pain the test causes, here is good news and another reason why you should stay up to date on your breast cancer screening. A new FDA approved product the MammoPad significantly reduces the discomfort many women feel during mammography.  MammoPad is an adhesive-backed, single use cushion that is easily applied to any standard mammography machine, without affecting image quality.

The MammoPad is warmer than the traditional ice cold platform the breasts usually have to lay on, and is more comfortable. It is also sanitized making it more cleaner too. What doctors are finding is that not only are women more comfortable, they also get excellent compressions and could sometimes see more breast tissue. Dr. Gail Lebovic, now lead surgeon at Baylor Breast Care Specialists of North Texas, invented MammoPad. BioLucent worked with Dr. Lebovic to perfect the product's design, how easy it would be to manufacture, and clinical testing. MammoPad is FDA cleared and is available worldwide.

In woman with fake boobs has real health worries, Busty and bothered wrote to women's medical health expert Dr. Judith Reichman asking if her breast implants will rupture during a mammogram or if there is a possibility that the implants will obscure signs of breast cancer. Dr. Reichman, who is NBC Today show's medical contributor on women's health, responded that both are valid concerns for the over four million women who have had breast augmentation. According the doctor, there were only 41 cases of implant ruptures during mammography reported to the U.S. Food and Drug Administration between June 1992 and October 2002.

As to breast implants obscuring mammography readings, implants can cause a 15 to 50 percent decrease in the mammographically visualized breast tissue and several studies have reported false negative mammograms -- those that missed the cancer -- in 12 to 67 percent of women with breast implants. So, it's a bit of good news and bad news but women with breast implants should not put off having mammograms because of fear that the implants will be damaged or that there is no point in having a mammogram because there is a possibility the implants will obscure the early signs of breast cancer.

The ComfortScan system is an advanced digital-imaging machine that uses high-intensity light to detect the earliest signs of breast cancer. ComfortScan is designed to detect tumor angiogenesis, or vascular change, the process whereby a cancerous growth surrounds itself with a dense network of tiny blood-filled capillaries. These vascular feeding tubes provide oxygen and nutrients to active tumors.

For women, the machine provides a comfortable examination, with gentle pressure on the breast. The new imaging capabilities overcome certain density limitations associated with mammography, takes only a minute, and can be used for premenopausal women and women on hormone therapy. In addition, there is no radiation involved with the ComfortScan, so there is no risk of exposure for the woman. If ComfortScan proves to be reliable in testing, this will be a welcome change from the current screening methods being used to detect early breast cancer.