FORT WORTH, Texas (Forth Worth Star-Telegram)- The best evidence yet that mammograms save lives - a lot of lives - is presented in a new long-term Swedish study that dates to 1968, when no screening was taking place because mammography had not yet been introduced.

The study, which involves 6,807 women whose breast cancer was diagnosed between 1968 and 1997, has found that regular, organized mammographic screening resulted in a 63 percent reduction in breast carcinoma deaths.

It shows that clinical screening in the community - outside a research setting - substantially reduces breast carcinoma mortality, says Dr. Laszlo Tabar, a world-renowned mammographer who reported on his recent research at a lecture this month in Fort Worth. His latest study was published in the June issue of the American Cancer Society journal, Cancer.

Tabar is director of mammography at Falun Central Hospital in Falun, Sweden, and teaches in the radiology department at the University of Uppsala Faculty of Medicine in Uppsala, Sweden.

He has devoted much of his career to establishing the value of mammogram screening.

Tabar's 29-year follow-up to his landmark study in the late 1970s, which set a baseline for breast cancer mortality rates before mammography was widely available, encompasses women from two counties in Sweden and compares three time periods: 1968-1977, when screening was not available; 1978-1987, when he conducted a randomized controlled trial in women ages 40 to 74; and 1988-1996, when all women in the two counties ages 40 to 69 were invited to undergo screening.

Women in the last group who underwent annual screening - 85 percent of those invited, on average - had by far the best breast cancer survival rates.

A recent national study of 200 women in whom cancer was newly diagnosed, released this month by Consumer Health Sciences, found that women in this country who discovered their tumors through mammograms had a significantly earlier stage of cancer and were least likely to have had a modified/radical mastectomy when compared with women who detected their breast cancer through self-examinations and other detection methods.

"As we recognize Breast Cancer Awareness Month, we must re-emphasize the importance of routine mammograms in early detection," says Joan Sinopoli, president of CHS, a 5-year-old consumer health care market research and consulting company. "To the degree that mammography, combined with monthly self-exams, enhances early detection and ultimately survival, we must ask ourselves why more women aren't availing themselves of this preventive treatment."

Earlier studies have shown that cancer detected through self-exams is more likely to be advanced and leads to the need for more aggressive treatment. However, guidelines for mammograms, especially for people under 50, are still controversial.

Most of the women between the ages of 40 and 60 in the CHS study reported detecting their cancer through self-examination. Most of those whose cancer was detected by mammogram were significantly older - 60 to 79.

Some 38 percent of women in the CHS study detected their cancer through mammogram, 42 percent through breast self-exam and 20 percent through a medical professional.

With such strong evidence that early detection is more effective and that mammograms are the most effective tool for early detection, most cancer experts recommend a baseline mammogram at age 35 and annual screenings beginning at age 40, says Dr. John Coscia, medical director of the Breast Care Center of Texas.

"There's no question it's saving lives," says Coscia, a Fort Worth radiologist who studied under Tabar.

"Dr. Tabar was in charge of the biggest study ever done to see if mammograms can save lives, back in the late '70s, and found a 30 percent mortality reduction," Coscia says.

Coscia predicts that digital mammography, a relatively new development in detecting breast cancer, will be widely available in about five years. Digital mammography machines utilize computer technology to enhance mammogram pictures.

When digital mammograms won Food and Drug Administration approval in February 2000, the FDA said they appear as good as - but not better than - regular X-ray film mammograms in detecting breast cancer.

The major advantage to digital images, Coscia says, is that they can be quickly transmitted over the Internet anywhere in the world for medical consultation with experts. Another advantage of digital equipment is that the mammograms can be stored electronically, meaning there are fewer lost films and less floor space is needed to store them, so that any changes in breast tissue can be followed over many years.

"With digital imaging, we also have a wider latitude," the range of dark and light portions in an image. "That is an advantage for some women with very dense breasts, because very dense tissue and tumors both show up as white or light spots on mammograms," Coscia says. "You can complete the exam with fewer pictures and less time, but the compression needed is about the same."

The biggest disadvantage right now is that the only machine approved so far runs $450,000 to $500,000 vs. the best current film X-ray mammography machines, which cost about $80,000 to $90,000.

More important than technology, though, says Coscia, is having mammograms done by an experienced radiologist dedicated to breast imaging.

Copyright 2001 The Fort Worth Star-Telegram. All rights reserved.