Between Us, the breast cancer support group, which has arranged a series of activities to heighten public knowledge of this disease. Among the speakers will be Dr. Annette Brown, a radiologist whose Fifth Avenue practice specialises in mammography and ultrasound.

Dr. Brown is also assistant professor of radiology at New York State University, chairperson for the New York Metropolitan Mammography Society, a media spokesperson for the American Cancer Society, and a member of President Clinton's task force on breast cancer. She has published articles on breast cancer and appeared on television.

Jamaican-born Dr. Brown is the sister of Mrs. Michael King of Bermuda, and will participate in the Bermuda Breast Cancer Education Week activities. In this interview, she discusses the disease and its ramifications, as well as the importance of early detection.

* * * Breast cancer kills.

That is the chilling message New York radiologist Dr. Annette Brown wants women who ignore their breasts to understand.

Refusing to carry out self-examinations, have regular medical check-ups or mammograms, ignoring lumps or other warning signals, could be tantamount to a woman signing her own death warrant.

Also, breast cancer can be prevented.

The only hope, therefore, is early detection.

"I cannot stress that enough,'' Dr. Brown said. "It is very important to detect the disease early because that is our only chance to effect any kind of cure. We don't understand what causes breast cancer, so the only tools we have available to us are diagnostic tools.'' In the United States, it is estimated that over 180,000 women will develop breast cancer this year, and of that number 45,000 will die. Canada's breast cancer rate is nearly as bad.

"The mortality rate has not changed for many, many years,'' Dr. Brown said of the US statistics. "We are talking a war here. It is a terrible business.'' Indeed, so bad is the problem that women in the US are now demanding that more money be devoted to research into the causes of breast cancer.

"Women are claiming that if this was a man's disease they would have found a cure already,'' Dr. Brown said. "On the premise that if they don't look after themselves nobody else will, women's advocacy groups have taken a leaf from the AIDS activists' book and are pressuring Government for more money for breast cancer research.'' The radiologist noted that while black women in the US had the lowest incidence of breast cancer, they had the highest mortality rate.

"The reason is late diagnosis. They are not doing self-examinations, having mammograms or coming to physicians early enough,'' she said.

As a specialist in mammography and ultrasound, Dr. Brown has heard every excuse imaginable from patients who failed to seek early medical help. These ranged from being too busy to: would rather not know, couldn't leave the kids, turned it over to God and prayer, hoped it would eventually go away.

But the greatest of all was fear. Fear of losing a breast; fear of losing the man in their lives; fear of radiation from mammography; fear that a mammogram would hurt.

For all the excuses Dr. Brown has sound answers. "To the women sitting at home with a tumour, I say: `If you don't do something you will surely die of this disease. It is not going to get smaller or disappear if you don't seek attention. This is one case where what you don't know will hurt you.'' "For the women who claim they're leaving it to God and prayer, I say: `At least you should pray intelligently. Don't bother God for no reason. Be specific. You have to explain your need. If you don't know there is a cancer in your breast, how can you get God to help you?'' "For the women who have heard that mammograms hurt, or fear a risk of radiation, I say: `A mammogram is not the most comfortable examination on earth, and I wouldn't choose to have one every day, but it is only uncomfortable for a few seconds. If we are talking life and death, a little discomfort should be the least of our worries. In any case, there are many medical procedures which are much more uncomfortable, so discomfort is not an excuse.'' As to radiation risks, Dr. Brown said the levels involved in mammography were insignificant.

"People fly all over the world and think nothing of it, so I don't know why they make a fuss about having a mammogram,'' she retorted.

Nor should women worry about losing their man if they were diagnosed with cancer.

"A lot of women are terrified that the man in their lives will leave them if they know they have cancer, so they put off seeking treatment,'' the radiologist said. "It is hard to believe that we are talking about a life when a woman says she would rather sit there with a tumour in her breast than run the risk of losing her partner.'' For the women who avoided seeking treatment through fear of losing a breast, Dr. Brown had words of comfort: "The sooner you take care of the problem, the less likely you are to lose your breast. Early detection is the key. A very small tumour can be treated with a lumpectomy, for example, whereby only the lump and not the whole breast is removed.'' Noting that smoking was a leading cause of breast cancer in women, the radiologist said it never ceased to amaze her when patients arriving for mammograms were so nervous that they went outside for a cigarette.

"That's the wildest part -- they don't mind puffing away, yet they are afraid of knowing what is in their breast!'' Acknowledging that the very word cancer struck fear in most hearts, Dr. Brown said this must change.

"I think we have to demystify the word cancer. If we cannot say the word we are always going to be scared to death. You can drop dead of a heart attack -- in fact, it is the leading cause of death -- yet people are less afraid of heart attacks than they are of cancer.'' Stressing that she was not out to scare women but rather to make them aware of the seriousness of breast cancer, Dr. Brown said the reality was that the disease was no respecter of persons and affected women of all races and socio-economic levels.

"I want women to clearly understand my message: Early detection is vital.

There is no reason to die needlessly. They can do something for themselves.'' Although she listed a lump or thickening which does not go away or seems to change; persistent swelling, puckering or dimpling; skin irritation; pain, or nipple tenderness as typical signs and symptoms of breast cancer, Dr. Brown warned women not to conclude that, because they did not exhibit any of these, they were automatically cancer-free.

Similarly, classic risk factors, such as heredity, were not the be-all and end-all of diagnosis either.

"The majority of women who develop breast cancer have none of the known risk factors so they can't depend on those as any sort of guarantee. Women have to be vigilant and take care of their breasts.'' Explaining why mammograms were important, the radiologist said they picked up tumours years before they could be detected by a physician or patient. "And some cancers you don't feel at all,'' she added.

Citing American Cancer Society guidelines, Dr. Brown said that women should begin examining their breasts once a month, one week after their period, at age 20. At age 30, the examinations should be also done by a physician.

Mammograms should begin at age 40, when the breast was fully mature, so that later on the physician would have something to compare subsequent mammographs with. And when changing doctors, women should transfer all mammogram records to them. From 40 to 49, women should have a mammogram every two years, and from age 50, every year.

As part of Bermuda Breast Cancer Education Week, Dr. Brown will be the guest speaker at a public meeting on October 29 at St. Paul's Christian Education Centre in Paget.

For further details of Bermuda Breast Cancer Awareness Week activities between October 25 and 29, refer to the Bermuda Calendar, or telephone Mrs. Shirley Humphreys at 236-3287.