A Message From The Creator

A Message From The Creator

Women’s News: Saudi Women to Get Their Own ‘City’

Women’s News: Saudi Women to Get Their Own ‘City’

Inspirational Woman Of The Day: Tarja Halonen

Inspirational Woman Of The Day: Tarja Halonen

Women’s Health: The Latest Mammogram Controversy: Density

Women’s Health: The Latest Mammogram Controversy: Density

Women’s Health: The Latest Mammogram Controversy: Density

Health Journal

Many Women Aren’t Told Their Breast Type May Cloud Cancer Screening; More States Consider Notification

Nancy Cappello had annual mammograms for a decade and each time radiologists noted in their reports that she had dense breast tissue. But doctors never told Ms. Cappello, nor did they warn her that it could make her mammograms less reliable.

When her doctor found a suspicious ridge during a manual exam eight years ago, she had a mammogram and an ultrasound on the same day. The mammogram again spotted nothing amiss, but an ultrasound found a tumor the size of a quarter. Her breast cancer had also spread to 13 lymph nodes.

Ms. Cappello, then 51, was dismayed to learn that the tumor wasn’t visible on a mammogram because dense breast tissue like hers can frequently hide cancer from view. “I kept asking my gynecologist, ‘Why don’t you routinely tell women this?’ And the answer I got was, ‘That’s not the standard procedure,’ ” she says.

In 2005, while still undergoing chemotherapy, radiation and surgeries, Ms. Cappello, an education administrator in Woodbury, Conn., started a campaign called “Are You Dense?” to educate other women about dense breast tissue.

Thanks in part to her efforts, last month, New York became the fourth state, after Connecticut, Texas and Virginia, to require radiologists to inform women if they have dense breasts along with their mammogram results. Similar bills are pending in 12 states and Congress. They face opposition from insurers and major medical groups concerned that the information could raise health-care costs and scare women unduly.

Studies show that having dense breasts raises the risk of developing breast cancer fourfold to sixfold. “It’s a greater risk factor than having a mother or sister with the disease,” but few women know this, says Deborah J. Rhodes, a preventive medicine specialist at the Mayo Clinic in Rochester, Minn. “Most of the physicians ordering these tests are also in the dark about this and the implications for women,” she says.

Ultrasounds and MRIs are much more effective at spotting breast cancer. Studies show that ultrasounds find three to four additional cancers per 1,000 women with dense breasts that mammograms miss. But those tests are usually reserved for women at high risk of developing breast cancer. Using them in addition to mammograms for women with dense breast tissue could add considerably to the cost of screening.

Women’s breasts are a mixture of dense tissue and fatty tissue (which is less dense), and generally become more fatty with age. Density can’t be determined in a physical exam, only by imaging. An estimated 66% of premenopausal women, and 25% of postmenopausal women, have breasts that are dense enough to interfere with mammogram accuracy, according to a landmark 1996 study.

In studies of thousands of patients, Thomas Kolb, a New York radiologist who specializes in breast-cancer detection, showed that mammograms missed 60% of cancers in women with the densest breast tissue that were found on ultrasound. Other studies have showed similar results.

Comparing Imaging Costs

Based on the national average Medicare reimbursement:

  • Film mammogram, $81.35
  • Digital mammogram, $139.89
  • Breast Ultrasound, $99.39
  • Breast MRI (both breasts) $716.83

Source: American College of Radiology

“I, as a radiologist, have a problem telling a woman with dense breasts that her mammogram is normal when I know it could be inaccurate 60% of the time if she has cancer,” says Dr. Kolb.

Still, the American College of Radiology says there isn’t enough evidence to recommend that women with dense breasts have routine ultrasound screening.

The American College of Obstetricians and Gynecologists says it is up to radiologists, not the OB-GYNs, to determine whether mammograms are sufficient. ACOG also opposed the bill in New York state because it requires radiologists to advise women with dense breasts that they may have an increased risk of breast cancer.

“Most women of child bearing age will receive this notification and they’ll say, ‘Oh my God, what should I do now?’ ” says Donna Montalto, executive director of ACOG’s New York chapter. OB-GYNs will likely recommend that they have ultrasounds—but mainly because of the threat of malpractice suits if breast cancer is missed, she says. “That’s defensive medicine.”

Some physicians think that women with dense breasts should have regular ultrasound screenings—or at least the option to consider it. “The vast majority of women are capable of hearing this information and not freaking out,” says the Mayo Clinic’s Dr. Rhodes, who is studying a new technology, Molecular Breast Imaging, that uses a tracer substance that makes cancer cells highly visible, and which she says shows promise in detecting cancers in dense breast tissue.

Jean Weigert, an executive with the Radiological Society of Connecticut, lobbied against the notification bill there on the grounds that it would increase costs and anxiety without much benefit. But once it passed, in 2009, she was impressed with its impact. Pooling data on 78,000 women in six different practices, Dr. Weigert found that about half of the women, or 8,651 patients, with dense breast tissue went on to have ultrasounds which found 28 cancers that weren’t visible on mammograms. “We are definitely finding more cancers, most of them at very early stages,” says Dr. Weigert

Connecticut, the first state to pass a notification bill, also requires insurers to pay for ultrasounds for women with dense breasts. According to Dr. Weigert’s analysis, the additional screening for those 8,652 women cost $2.15 million, or $110,000 for each additional cancer found. Finding cancers early saves many times that amount compared with the cost of late-stage cancer treatment, she notes.

The dense-breast debate comes at a time when the value of breast-cancer screening in general is being questioned. The U.S. Preventive Services Task Force in 2009 recommended against annual mammograms for women in their 40s and said that women 50 and older should have them only every other year. (ACOG and many breast-cancer groups still recommend them annually starting at age 40.)

Last week, in an editorial in the British Medical Journal, two Dartmouth researchers accused the advocacy group Susan G. Komen for the Cure of overstating the value of early detection in its ads while not telling women that screening can result in many false alarms and treatments for cancers that might not have been life-threatening. “Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today,” Chandini Portteus, Komen’s vice president of research, evaluation and scientific programs, said in a statement. Other experts say that breast-cancer deaths have dropped 30% in the U.S. since 1990, due at least in part to early detection from widespread screening.

Even without legislation, some experts note that women can ask about their breast density, since radiologists routinely report that information to physicians. “If women are at all concerned, after a mammogram, they can call their doctors and say, ‘Listen, do I have dense breasts? Do I need anything further?’ ” says Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission.

Write to Melinda Beck at HealthJournal@wsj.com

Inspirational Woman Of The Day: Tarja Halonen

Born Tarja Kaarina Halonen, December 24, 1943, in Helsinki, Finland; daughter of Vieno Olavi and Lyyli Elina Loimola Halonen; married Pentti Arajärvi (an attorney), August, 2000; children: (with Kari Pekkonen) Anna. Education: Earned master of laws degree from the University of Helsinki, 1968.

Addresses: Home —Helsinki, Finland. Office —Office of the President of the Republic of Finland, Mariankatu 2, 00170 Helsinki, Finland.

Career

Social affairs and general secretary, National Union of Finnish Students, 1969-70; attorney, Central Organization of Finnish Trade Unions, 1970-74, 1975-79; joined the Social Democratic Party (SDP) of Finland, 1971; parliamentary secretary to Prime Minister Kalevi Sorsa, 1974-75; elected to the Helsinki City Council, 1977, and served until 1996; SDP member of parliament, 1979-2000; minister of social affairs and health, 1987-90; minister of Nordic cooperation, 1989-91; minister of justice, 1990-91; foreign affairs minister, 1995-2000; elected president of Finland, 2000; reelected, 2006.

Sidelights

Voters in Finland elected Tarja Halonen as their country’s first female president in 2000, but her re-election campaign six years later received some unusual media attention outside of Scandinavia. In the fall of 2005, American television personality Conan O’Brien turned the resemblance between himself

and Halonen into a recurring gag on his nightly NBC show. O’Brien even traveled to Finland a month after Halonen’s narrow victory at the polls to meet the left-leaning Social Democrat in person. Asked by Newsweek ‘s Nicki Gostin if he felt he had any influence on the election, O’Brien joked, “I either helped her to win or almost caused her to lose.”

 

Halonen was born on Christmas Eve of 1943 in Helsinki, Finland’s capital city. Her parents named her “Tarja” a Russian variant of Darius, the ancient Persian leader. The name was not on the official list of girls’ names at the time, and was an even more unusual choice given the fact that at the time of her birth, Finland was at war with the Soviet Union in the latest of a history of skirmishes with its powerful neighbor to the East. The Halonens lived in Kallio, a part of the city that had traditionally been home to factory workers and their families since the late nineteenth century.

Like many of her postwar generation, Halonen was active in a number of leftist political movements during her time as a student at the University of Helsinki. She continued her involvement with such organizations after she earned a master of laws degree in 1968, and took a job with the National Union of Finnish Students as its social affairs and general secretary. In 1970, she was hired by the Central Organization of Finnish Trade Unions as an attorney, and formally joined the Social Democratic Party (SDP; in Finnish Suomen Sosialidemokraattinen Puolue ), Finland’s most powerful political entity, a year later.

In 1974, Prime Minister Kalevi Sorsa appointed Halonen to the post of parliamentary secretary, which she held for one year before returning to her job as a labor attorney. In 1977, she won a seat on the Helsinki City Council, and would serve five terms in all. Two years later, she was elected to the Eduskunta , Finland’s unicameral parliament. Her first cabinet post came when Harri Holkeri, the new prime minister, appointed her to serve as minister of social affairs and health in 1987. From 1989 to 1991 she held the post of minister of Nordic cooperation, and was Finland’s justice minister between 1990 and 1991. After 1995 elections, which returned SDP to power, new prime minister Paavo Lipponen named her to serve as minister for foreign affairs. She earned high marks during her five years on the job, particularly for standing firm against a proposed membership in the North Atlantic Treaty Organization (NATO), a collective defense unit created in the aftermath of World War II.

In 1999, Halonen announced her intention to run for the presidency in the coming year’s elections. Participation by Finnish women in government, even at the parliamentary level, dated back to 1907, a year after Finland became the first European country to grant women the right to vote. By the 1990s, the country boasted some of the most impressive statistics in the world for the number of women holding elected office or appointed government posts. The first female candidate for Finland’s presidency was Helvi Sipila in 1982, and 12 years later the country’s then-minister for defense, Elisabeth Rehn, narrowly lost to Martti Ahtisaari, whom Halonen would succeed.

In the 2000 contest, Halonen was one of four women on the ballot for president, but her main foe was a fifth candidate, former prime minister and head of the Centre Party, Esko Aho. Because that party drew much of its support from outside Finland’s cities, Aho courted votes from more conservative rural Finns by highlighting the differences between himself and Halonen. She was a single parent who had never married the father of her daughter, Anna, was estranged from the Lutheran church, and had once headed Finland’s leading gay-rights organization in the 1980s. In the January 16 voting, neither Halonen nor Aho won the necessary majority, and a run-off election took place on February 6 in which Halonen squeaked by with 51.6 percent of the vote. She was sworn in as Finland’s first female president on March 1, 2000.

Changes in Finland’s constitution had recently reduced the powers of the president, relegating them to the domestic sphere, but Halonen remained commander-in-chief for the country’s military forces, and voiced her opinion on foreign affairs when she deemed it necessary. She became known for frankness as well as for a rather down-to-earth personality, which resonated deeply with the characteristically sensible Finns. Her official Web page featured photographs of her two cats, Rontii and Miska, and when she was dubbed “Moomin-mamma” by the Swedish press—after a motherly cartoon character—the nickname took hold in Finland. A few months after taking office, she wed her longtime partner, attorney Pentti Arajärvi, in a private ceremony.

Halonen ran for reelection in January of 2006, and won a second six-year term after another run-off, this time against National Coalition Party candidate Sauli Niinistö. Again, it was a close election, with Halonen besting Niinistö in the January 9 contest by just three percentage points. Her campaign attracted an unusually high degree of international press attention thanks to Halonen’s frequent mentions on Late Night with Conan O’Brien , which airs on one of Finland’s cable-television channels. The jokes began in October of 2005, after the red-headed host was told that he resembled Halonen. “We decided to do a split screen and I’ve never gotten a laugh like that, ” O’Brien told Gostin in the Newsweek interview.

As election day in Finland neared, O’Brien endorsed Halonen’s bid for a second term and even produced mock political ads that skewered Niinistö and her other opponents. A few weeks after her election victory, O’Brien traveled to Finland, where Halonen presented him with an award for most entertaining television personality of the year, based on a public poll conducted by the country’s equivalent of TV Guide. A crowd of 2, 000 Finnish fans greeted him at the Helsinki airport when he arrived for his fiveday visit, with one holding a banner that read, according to the New York Times , “Tarja is our president but Conan is our king.”

Sources

Financial Times , July 10, 2000, p. 2.

Independent (London, England), February 8, 2000, p. 15.

Nation , April 10, 2000, p. 20.

Newsweek , March 13, 2006, p. 71.

New York Times , February 13, 2006.

Presidents & Prime Ministers , May 2000, p. 16.

Scotsman (Edinburgh, Scotland), May 13, 2004, p. 14.

— Carol Brennan

Read more: Tarja Halonen Biography – children, parents, name, history, born, time, year, Career, Sidelights – Newsmakers Cumulation http://www.notablebiographies.com/newsmakers2/2006-Ei-La/Halonen-Tarja.html#ixzz23Z0JLYsm

Women’s News: Saudi Women to Get Their Own ‘City’

Reporter’s Notebook by ABC News’ Lara Setrakian:

Separate has never meant equal in Saudi Arabia. But a new women-only development in Saudi’s Eastern Province is aimed at moving women forward, easing more of them into the workplace.

The new industrial “city” is expected to create about 5,000 jobs in women-run factories and firms, The Guardian newspaper reported.  The site will be equipped “for women workers … consistent with the privacy of women according to Islamic guidelines and regulations,” the Saudi Industrial Property Authority (Modon) said in a statement.

Women and men are kept separate in the Saudi kingdom, where a strict interpretation of Islam dominates the public arena. That poses a specific challenge to women workers, especially at the lower end of the income scale. They often can’t interview for jobs with male bosses and need special accommodations to get to work, because they’re not allowed to drive or spend their wages on a driver.

That’s why Samar Fatany, a Saudi radio host and one of the Kingdom’s prominent female voices, says the all-female development is a good thing. What seems like more segregation to outsiders looks like empowerment in Saudis’ eyes.

“Otherwise, they won’t have that kind of opportunity to work,” Fatany told ABC News. “Their culture and environment won’t let them work any other way.

“It’s an opportunity to have an income, be financially independent. It’s an economic necessity.”

That point was clear in 2010, when I visited with women at all-female factories in Riyadh. Of the women who worked the assembly lines, packing boxes and manufacturing light fixtures, most were single mothers, abandoned by their husbands and desperately in need of an income. A wall separated them from the male factory workers on the other side, with only a few conveyer belts snaking through to unite the production line.

Those women wanted to work in segregated quarters. With their conservative families and personal religious values, they wouldn’t have taken a job that involved mixing with men.

The new development, to open next year,  falls in line with a Saudi government push to put more women in the workplace, a delicate balance between a more modern Saudi Arabia and the occasional backlash from conservative clerics.

If Saudi men are threatened by women’s empowerment, some say it might be because they’re suddenly being outperformed in the workplace.

“To me, a Saudi woman is a better worker than the Saudi men,” said Khaled al Maeena, editor-in-chief of the Saudi Gazette and Fatany’s husband. “They work hard and they try hard.”

He says Saudi women place more value on their hard-won opportunities.

“Women are more committed, they like to work more, they don’t give excuses, disappearing as men do,” he said. “It’s a state of mind.”

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