Denora Dingman received regular mammograms every two years, but it wasn't until she examined herself late last year that she discovered a lump in her breast.
The 47-year-old Columbia resident underwent a lumpectomy and radiation treatment to remove the cancerous cells earlier this year at Howard County General Hospital.
She credits the breast self-exam and immediate treatment with catching the disease before it spread to other parts of her body. Now she encourages all women to seek early treatment.
"If you catch it early, the treatment is much less onerous and the survival prognosis is much better," she said.
Howard County General and area health maintenance organizations emphasize that message this month, which is national Breast Cancer Awareness Month, sponsored by the American Cancer Society and other organizations.
To help promote the importance of early cancer detection, area health care providers are offering mammograms and other services at reduced rates, even free of charge for those who meet certain age and income qualifications.
And throughout the area, health-care workers are wearing pink ribbons to draw public attention to Breast Cancer Awareness Month.
"It's a way of opening dialogue," said Mary Ann Wilkinson, vice chairwoman of the Howard County Commission for Women. "It's been a hidden topic."
The need for better education about breast cancer also is the first major initiative for the commission's new committee on women's health, the first ever formed by the 13-year-old organization.
"There's obviously a need for women to get screened and prevent breast cancer or learn how to screen themselves," said Ms. Wilkinson, the committee chairwoman.
Nationally, breast cancer is the second leading cause of cancer deaths for women, after lung cancer.
Higher mortality rate
It is of particular concern in Howard County, which has a history of higher mortality rates from breast cancer than the statewide average, according to the state Department of Health and Mental Hygiene.
In 1990, for example, the most recent year for which figures are available, Howard County's breast cancer death rate was 30 per 100,000 women, compared with a statewide average of 28.6 deaths per 100,000 women for the same period.
One reason for the difference may be that women with high incomes, a group that includes many county residents, tend to bear children at later ages, increasing their risk of contracting the disease, said state epidemiologist Norma Kanarek.
But she said women with higher incomes who get the disease also should be in a better position to reduce their subsequent risks, because they tend to have medical insurance and seek early intervention.
"The wealth factor works for them because they have insurance for diagnosis and treatment," Dr. Kanarek said. "They're better counseled and they do have better survival rates."
Health officials voice concern that many poorer women do not get regular mammograms -- simple diagnostic X-rays of breast tissue -- because of the costs, which can be more than $100.
The American Cancer Society recommends that women between the ages of 35 and 39 have a baseline mammogram, while those 40 to 49 have an annual or bi-annual mammogram. Annual mammograms are suggested for women 50 and older.
"A lot of women just don't have the money to make mammography a priority," said Susan Fosler, Breast Cancer Awareness Month spokeswoman for the Maryland division of the American Cancer Society.
At Howard County General Hospital, mammography screenings have been reduced to $50 from $104. The special rates, which end Oct. 31, have attracted women who normally would not have had mammograms.
As of Friday, about 300 women had scheduled mammography appointments at the hospital, said Patricia Smith, coordinator of mammography services at the hospital. Of the 60 seen so far, about five have been called back for further diagnosis, she said.
"We've had a lot of first-timers," said Ms. Smith. "A lot of middle-agers who should have come in 10 years ago."
Even before that program, some county women had come to see the importance of regular breast cancer screenings, despite the cost and inconvenience.
Pearl Chou, a 50-year-old Columbia resident, used to be among those who regularly skipped mammograms, but decided to have one last year at her doctor's urging.
The mammogram revealed that minute portions of Ms. Chou's breast tissue had calcified -- an indicator that something could be wrong. In March, Ms. Chou learned that she had breast cancer.
"My first thought was, I'm going to die," recalled Ms. Chou. "I thought I was going to be scarred for life."
Ms. Chou, who had a lumpectomy and now shows no signs of cancer, recalled that she had regularly examined herself for lumps but never felt anything. "Women should, number one, pay attention to their own bodies," Ms. Chou said. "And you have to take time to get a mammogram."
The following is a sampling of local mammography screenings and other services being offered as part of Breast Cancer Awareness Month:
* Howard County General Hospital is offering $50 mammograms for women who have no symptoms of breast disease. To make an appointment for a mammography screening, call 740-7878.
* Columbia Medical Plan is offering mammography screenings, as well as pelvic exams and Pap smears at reduced rates. Call 461-0503 for more information.
* The county health department's Breast and Cervical Cancer Screening Program offers free mammography screening, clinical breast exams, Pap smears, and pelvic exams for women over 50 who are uninsured, underinsured or who have high deductibles on their medical insurance. Lab fees and transportation also are covered. For more information, call 313-7500.
A complete list of local screening programs accredited by the American College of Radiology is available by calling the American Cancer Society at 1-800-227-2345.