Routine Questionnaire Improving Breast Cancer Screening and Detection Nationwide

Data Contributed By 200,000 New Hampshire Women On Almost a Million Mammograms So Far

October 12, 2009

Tracy Onega, PhD

Tracy L. Onega, PhD

Each year in New Hampshire, 800 to 900 women are diagnosed with breast cancer. Often, the cancer has been first detected by a mammogram. Mammography is the most commonly used screening technique for cancer in women who have no symptoms.

In New Hampshire, many women fill out the same detailed questionnaire each time they get a mammogram. That's because since 1996, researchers at Dartmouth-Hitchcock's Norris Cotton Cancer Center, and radiologists, mammography technologists, and women throughout New Hampshire, have been working together to learn more about finding breast cancer in its earliest stages. As a result, the New Hampshire Mammography Network (NHMN) has collected data on more than 200,000 women-and almost a million mammograms!

The goal is to improve the health of New Hampshire women by improving breast cancer screening and detection. To accomplish this, NHMN has created a comprehensive tracking database that can follow, over time, the outcomes of women receiving mammography and other breast procedures such as ultrasound or biopsy.

Together, these women can take credit for contributing to valuable discoveries that can affect breast cancer detection nationwide. The information collected helps researchers to understand why some women never experience breast problems and why others do. Ultimately, the results of the study will teach women, physicians, clinics, and hospitals more about the causes of breast problems, and what kind of care is best.

Tracy Onega, PhD, is the director of NHMN and a researcher at Norris Cotton Cancer Center. Dr. Onega's research interests center on access to cancer care, including screening, treatment, and surveillance, and the effectiveness and use of new technologies for cancer screening and treatment.

Dr. Onega works with national colleagues, dozens of radiologists around the state, and thousands of New Hampshire women each year to study ways to improve early detection of breast cancer."Together, we're hoping to understand how new technologies, such as digital mammography and breast MRI, can best be used to benefit women," Onega says. "We want to minimize the stress of women getting false breast findings, while making sure to maximize the ability to detect breast cancer early, and decrease the chances of women dying from breast cancer."

Through a grant funded by the National Cancer Institute and the American Cancer Society, Dr. Onega is studying ways to improve how mammograms are interpreted by radiologists around the country. One area of focus is how the "density" of a woman's breast can affect the detection of breast cancer. Dr. Onega hopes to help radiologists assess breast density more consistently in order to be able to better interpret what they see in the mammograms of women who have dense breasts.

NHMN's continued collection of data is essential to gauging the impact of mammography on cancer detection, evaluating new mammography technologies, and finding ways to encourage women to get screened.
Information in the NHMN database has already provided valuable input on mammography. For example, NHMN data shows that 36% of New Hampshire women have either never had a mammogram before or have had an irregular schedule of screening. And 35% of women have had one or two mammograms and then not returned for over two years.

The NHMN data also shows that women who are screened every year for ten years have a 50% chance of being asked back for more imaging that turns out to show no cancer. Yet higher recall rates do not result in higher cancer detection rates. NHMN data also has shown that the presence of breast implants decreases the ability of mammography to detect breast cancer, but it is still unclear how this impacts women with implants who get breast cancer.

NHMN's continued collection of data is essential to gauging the impact of mammography on cancer detection, evaluating new mammography technologies, and finding ways to encourage women to get screened. The NHMN is one of only five mammography registries nationwide funded by the National Cancer Institute. The combined data from the five registries contains information about 7 million mammograms.

Because NHMN focuses on mammography as a screening tool, it needs to collect as much information as possible on every mammogram done in New Hampshire, in order to compare mammography histories of women who do and do not get breast cancer. Anything that may affect a woman's health, access to health care, or risk of getting a disease is important information for NHMN to study. For example, sometimes it is harder for women who are widowed or divorced to pay for regular mammograms. Understanding this will help influence public policy to ensure all women can have regular, affordable mammograms.

So Dr. Onega has a request for every woman in New Hampshire: "The next time you have your annual mammogram, and are asked to fill out yet another survey from the New Hampshire Mammography Network, please do! You'll know you are contributing to the understanding-and improvement-of an important, life-saving tool in the fight against breast cancer."

Making Strides Against Breast Cancer: This article first appeared in a special 8-page section of the Sunday, October 5, 2009, New Hampshire Union Leader. The special section was entitled, "Making Strides Against Breast Cancer." Norris Cotton Cancer Center is a Making Strides Stay Well sponsor for the 2009 American Cancer Society Making Strides Against Breast Cancer events being held throughout New Hampshire on Sunday, October 18, 2009 to raise money for the fight against breast cancer. For more information or to register for a walk, visit or call (800) 227-2345.