Battle Rages Against Breast Cancer

No bullets or missiles can be launched against this foe. No tanks or bombers can stop it. And unlike a lot of modern skirmishes that are intense but short-lived, the women are in a protracted battle against time and a tireless enemy.

The enemy is cancer -- breast cancer -- the No. 2 killer of women over age 40. According to the American Cancer Society, the enemy is winning. In the 1970s, one in 20 women over 40 were at risk of contracting breast cancer. Today, one in eight are susceptible.

For the past three years, DoD has waged a vigorous battle against breast cancer. Its weapons are education, early detection and prevention. Congress authorized -- in fact, demanded -- the battle, approving $25 million each of the last three fiscal years for DoD to wage a war against the disease.

An interdisciplinary team of representatives from each of the service medical corps and DoD health affairs oversees the battle plan. The plan concentrated first on improving access to medical care.

"Someone had recognized a problem with access, particularly to mammography," said Army Col. Doris Browne, deputy for medical research and development at the Army's Medical Research and Materiel Command, Fort Detrick, Md. She recalled hearing reports from women who said they waited a year or more for a breast cancer screening. So the triservice working group concentrated initially on getting women into clinics.

Access standards established under TRICARE, DoD's managed health care plan, eliminated long waiting periods for mammograms and other health care appointments, Browne said. In addition, different TRICARE regions and medical facilities established new programs to enhance breast cancer diagnosis and treatment.

For example, the TRICARE Pacific staff at Tripler Army Medical Center, Hawaii, developed a centralized tumor board. Each month, physicians at distant Pacific bases sit down at video- teleconferencing facilities with mammograms in hand and get screenings and advice from pathologists in Hawaii. This slashes the need for expensive, time-consuming medical evacuations and speeds up care to the patients, Browne said.

In Southern California, Naval Medical Center San Diego set up a breast cancer center that networks regional Air Force, Army and Navy facilities. Nurses manage cases, and a coordinator makes sure everyone gets the same level of education.

With programs like these improving access to care, the breast cancer working group launched the next phase of its battle plan -- educating patients and providers. Results have been spectacular, Browne said.

To help patients, TRICARE Region 6 in San Antonio produced an educational CD-ROM for patients. "It's fantastic," Browne said. "It helps patients maneuver through the health care system."

The battle plan also aimed educational efforts at primary care managers -- the medics patients first see and who refer patients to specialty care. The medics aren't necessarily educated beyond the basics about breast care, Browne said. Last year, the working group contracted with the American Medical Women's Association, which has since provided more than 6,000 primary care managers with more breast care knowledge.

This year, DoD expanded the training program, selecting a master faculty cadre for each TRICARE region to conduct regional training and education programs. "Next year, we'll move to a Web-based or videoteleconferencing platform," Browne said.

Browne is particularly proud of the assistance provided to smaller clinics without staff oncologists. "Through another contract, we're able to send radiation and medical oncologists to these facilities to conduct tumor boards," she said. Without the boards, patients would have to be referred to distant medical centers or civilian specialists.

Yet another contract agreement will produce a comparison of DoD programs with external programs and help DoD develop breast care policy guidelines, Browne said.

This year, DoD has continued regional plans and, where possible, exported them to other locations. For example, the Texas- produced patient CD-ROMs were shipped to all TRICARE regions, where they will be distributed by breast cancer centers, occupational medicine clinics and other places women go for health care.

Other new and ongoing breast care initiatives in DoD include mammography tracking systems, technician recertification, genetic testing and counseling.