480 WOMEN HERE HAVE BREAST CANCER *

E violent American war against breast cancer sometimes fail to take their

own advice, becoming inadvertent hypocrites and potential victims.

That could be a fatal mistake, as they are the first to admit. On the front lines of the fight, where Florida W e ekly travels in this issue, the real color is not pink but blood-red and mortal, and the most deadly foes are not the various configurations of breast cancer but ignorance and its ally, simple forgetfulness.

"My staff came to me and said I'd missed my mammogram, and I said, 'No. You show me,'" recalls radiologist Dr. Mary Kay Peterson. "I figured, 'OK, it's probably been a year and a half.'"

Not exactly. "Maybe I shouldn't tell you this, but I hadn't had a mammogram in three years," she admits. "Afterward, I had to have a biopsy and that scared the heck out of me."

At 46, Dr. Peterson sits on the board of the American Cancer Society, she volunteers for regional breast cancer organizations and she's a partner at Radiology Regional Care Centers in Naples and Fort Myers. She also has five children, a husband, and a grandmother who lost both of her breasts to cancer 45 years ago — a family history that puts her at greater risk.

Dr. Jeannie Moran and Dr. Denise Gay But even without a family history, the statistics of chance for any woman are unenviable: One in eight will have to endure the disease sometime in their lives, doctors say. In any population of 1,000 women — walking in the mall, crossing a campus, passing through the airport, looking for a job — one is likely have breast cancer and does not realize it.

If they don't identify their disease early, they're much less likely to survive.

This year alone, almost 200 women will probably die of breast cancer in Southwest Florida, according to statistics provided by the region's most muscular breast cancer association, the nonprofit Susan G. Komen for the Cure.

Most disturbing, perhaps, is this fact and its thorny statistics, being reported here for the first time: Between 2002 and 2007, many women in Collier, Lee and Charlotte counties stopped scheduling annual mammograms or performing the monthly self-examinations that demonstrably save lives for women over 40, or for those of any age with family histories of the disease.

FABIAN In some cases, they lived in relative isolation from care centers, or they lacked health insurance, comfortable incomes or even awareness. But in other cases, they came from middle class or opulent homes and educated backgrounds.

In Collier County, for example, women from households with incomes greater than $50,000 were 14.2 percent less likely to schedule annual mammograms in 2007 than in 2002, a trend that has shown no sign of abating. In Charlotte County, the decline was similar — such women were 13.8 percent less likely to monitor themselves.

In Lee County, women who found themselves divorced, widowed or separated were 10.9 percent less likely to remain vigilant with annual mammograms or monthly self-examinations. Women over 65 were 6.3 percent less likely to follow good medical protocol.

"My assistant took me to my first mammogram because I was scared out of my mind — it was still too close to my mother's death in 2002," says Dr. Denise Gay, a 38-year-old Naples periodontist and mother of two. She and her practice partner, Dr. Jeannie Moran, donate money from their practice, Olde Naples Periodontics, to Susan G. Komen each year and participate in the organization's annual fund-raising and awareness walk.

Dr. Gay contributes to honor her mother, who died at 62 from breast cancer that had spread to her bones after an eight-year remission, and whom she still can't speak about without visible grief. Dr. Moran herself is a breast cancer survivor now four years in remission. She did regular mammograms and self-examinations, which is how she discovered a tumor in 2005.

Even with all of that influence, during a conversation with a reporter, Dr. Gay realized that she probably hadn't followed up with another mammogram in two or three years. The date of her last one had escaped her.

"Your life just gets away from you, you get so busy," she admitted in a moment of surprise.

Officials are hard put to offer any certain explanation for this startling tendency to go to sleep at the wheel, but they can make some good guesses based on similar anecdotal evidence.

"An oncology nurse in Collier County told me that she thinks this is happening because people aren't as healthy as they used to be, and they have a lot of tests, and a mammogram is just one more they think they can do without," says Miriam Ross, the executive director of Susan G. Komen in Southwest Florida, which serves Hendry and Glades counties, as well as the three coastal counties in the region.

"Maybe if you're a woman with a family and kids, and in 2002 you're covered but in 2007 you're not, you're just not going to do it," says Ms. Ross.

"Fear is a factor too, but there has always been fear (of mammograms and of what examinations might reveal). What

corporate says is that breast cancer has been in the forefront for a long time, with a lot of positive stories and great strides in this area, and people have become complacent. Back in the 1980s, before Susan G. Komen was formed, the survival

rate, defined as living five years after detection, was 74 percent."

Ignoring or forgetting about the problem — becoming complacent — may very well kill some women, says Dr. Peterson.

"We know that nowadays 98 percent of patients who can detect a breast cancer when it's the size of a peanut or less can live five years or longer. So early detection is essential," she explains. "My fear is that by losing out on the preventative health care of mammograms, and continuing on (obliviously) as some women have been, we're going to see a lot more breast cancers five, eight or 10 years down the line, and our higher survival statistics are going to drop."

She's not the only one who fears the cost of ignoring the problem.

"What you see in a population when you screen their first mammograms is a lot of patients walking around with small cancers they don't know they have, from, say, a millimeter up to two centimeters — and those may go undetected by a physician or in a breast squeeze," explains Dr. Thomas Fabian, a principle in Advanced Imaging in Charlotte County, and a Susan G. Komen board member.

"Then (the rate of discovery) dies down because you've screened everybody and picked up those problems in the first wave, so you start looking for new cancers in your existing patients two to four years down the road."

If those patients remained habitually alert, the world might be a happier place. But that doesn't always happen.

"What frustrates you is that oftentimes patients don't come back," Dr. Fabian says. "And when they disappear for three or four or five years and come back with a cancer, instead of it being a couple of millimeters and curable, it's three or four centimeters."

And incurable.

The recession, too, may indirectly cost some women their lives, Dr. Peterson suggests. Those who have lost jobs or insurance or find themselves and their families struggling with reduced incomes may fail to recognize that help is always at hand.

Even without insurance or money, women are surrounded by a powerful support system of public and private organizations that will find a way to provide mammograms and other care, for everybody.

"Just call us," pleads Miriam Ross, the Susan G. Komen official (1-877-GO KOMEN, or www.komenswfl.org).

But there may be no help for those who don't reach out in time and end up drawing the short straw in the roulette of statistics.

"A 37-year-old woman came to me recently and her left breast was swollen to almost twice its normal size," Dr. Peterson says. "She was just divorced, she has three children, and her employer had dropped her health insurance because the company could no longer pay for it, they told her. But she didn't want to complain because she had to have the job. She was afraid of losing it."

There is no happy ending to this story. Pressed on the likely outcome, Dr. Peterson is candid and unequivocal.

"She's going to die," the doctor says. "She can't survive this. I can make her more comfortable, and we can remove the breast and the cancer there, but this is not survivable."

Caretakers themselves may live in a vale of tears, since similarly anguishing stories multiply in spades during the course of their working lives. On days when Dr. Peterson has to confront the specter of breast cancer mortality that could have been avoided, "I can walk out of the office in meltdown mode," she says.

"My faith is the thing that keeps me going through this, and my passion to make a difference in people's lives. And I am very much an optimist that we can make things better. If I weren't, I couldn't do this."

Faith and support, support and faith — both can be indispensable tools of survival that must accompany good medicine, insist many doctors, and their patients and survivors.

"Support is the most important thing in my opinion — personal-level support," says Janet Gainey, a 62-year-old Bonita Springs resident and retired teacher. She lists the intense friendships of other women, the devotion of her husband and three sons, and the love of her two younger sisters as key reasons she's survived in a 20-year, on-again-off-again battle with a disease that will ultimately kill her. "Metastatic breast cancer (cancer that spreads in the body, in her case to the lungs) is always fatal, and I'll have chemotherapy every Monday for the rest of my life," she explains. "But this isn't tough. It's just something you live and deal with, if you're able to. I have been lucky. Because of my support, and the will to fight this and the desire to help other people (Mrs. Gainey volunteers at Susan G. Komen), I'm here. I've had the best health care, the best situations, the best friends and family, and I have hope and a positive attitude.

"I know a lot of people feel that faith is equally as important as personal support, and I think that faith is important. But personal-level support is the most important thing to me, and it's faith based. It absolutely saves lives."

Support, then, is the raison d'être of the stories that follow — only a few of many on the southwest coast.