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Helping Women Help Themselves

With support from NCI and the American Cancer Society, Tracy Onega, PhD, is making a big public health impact in breast cancer

One of the most satisfying aspects of Tracy Onega's work with the New Hampshire Mammography Network (NHMN), she says, is creating an opportunity for the women of New Hampshire to feel like they are contributing to a significant public-health outcome.

Focus article photo

Tracy Onega, PhD

The Network, a registry of mammograms that is helping doctors worldwide to better understand breast health issues, including breast cancer, is one of just five such registries in the United States funded by the National Cancer Institute. Since the late 1990s the NHMN has collected data from more than a million mammograms performed in the state, and the combined data from the five registries contains information about 7 million mammograms. While the registry is now closed, the data collected will continue to be useful for decades.

"There's a big public-health impact," says Dr. Onega, who is assistant professor of community and family medicine at The Geisel School of Medicine at Dartmouth and a member of the Cancer Control Research Program at Norris Cotton Cancer Center. "I think women feel it's a way to be active in helping with women's health issues."

The American Cancer Society (ACS) helps fund the program through ACS's Assessing and Improving Mammography (AIM) program. "ACS has really helped AIM develop into an effective intervention program from the registry," she said.

Mammograms: An Essential Breast Cancer Tool

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.

Photo: Digital mammogram of a breast

"We're hoping to understand how new technologies, such as digital mammography and breast MRI, can best be used to benefit women," says Dr. Onega.

The goal of NHMN, which Dr. Onega directed, was to improve the health of New Hampshire women by improving breast cancer screening and detection. To accomplish this, the registry created a comprehensive tracking database that followed, over time, the outcomes of women receiving mammography and other breast procedures such as ultrasound or biopsy. 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.

Dr. Onega is also researching ways to improve, for radiologists, interpretation of mammograms. The density of a woman's breast tissue can affect the detection of breast cancer, for example. Dr. Onega hopes to help radiologists assess breast density more consistently in order to better interpret mammograms of women who have dense breasts.

Understanding How New Technologies Will Benefit Women

By looking back Onega is able to look forward. NHMN's 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.

"Together, we're hoping to understand how new technologies, such as digital mammography and breast MRI, can best be used to benefit women," she 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."

Valuable Mammography Input
  • Information in the NHMN database has already provided valuable input on mammography. For example, NHMN data show that 36 percent of New Hampshire women have either never had a mammogram before or have had an irregular schedule of screening. And 35 percent 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 10 years have a 50 percent chance of being asked back for more imaging that shows 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.

May 07, 2012