In the Navajo culture, we say that cancer is the sore that does not heal. When you speak about it openly, you wish it upon yourself or others. Talking about it openly does not respect it.

In mainstream U.S. culture, cancer was also once the big ''C.'' No one spoke openly about it because it was once a disease with little hope. But now, if breast cancer is found early, the survival rate is 98 percent; getting your mammogram is talked about as openly as getting your flu shot.

I am a 19-year survivor of breast cancer. I knew women who were diagnosed at the same time I was, with the same stage, but somehow they didn't make it. But I don't feel lucky; I think that my life has been spared for a reason. This is why I do outreach.

Currently, there is neither a cure for breast cancer nor any known way to prevent it, making early detection - annual mammograms - the key to survival. All women age 40 and over should get a mammogram every year.

However, a little more than a third of American Indian women over the age of 40 - only 37 percent - receive annual mammograms. Hispanic women do slightly better, with 38 percent. These numbers help explain why only 53 percent of New Mexico women age 40 and over receive annual mammograms. But if you look at the more than 150,000 women in New Mexico who lack health insurance, that number plummets to 25 percent.
 

How do you increase the number of women who have access to screenings?

The New Mexico Breast and Cervical Cancer Early Detection Program provides mammograms and early detection services through the county health departments to uninsured and underinsured women with incomes at or below 250 percent of the federal poverty level and who are between the ages of 30 and 64 (screening for women age 65 and over is covered by Medicaid).

Approximately 46,000 women are eligible for this program, but current funding can only provide mammograms for less than 15 percent of them.

In my outreach work, I am faced with challenges. I cannot follow the traditions of my culture and stay silent when women need education and encouragement to go get their mammograms. But in talking openly about breast cancer, I have been yelled at and scolded by my nation's elders for breaking through our past ways of addressing this disease.

Women in other cultures face similar taboos - social barriers, combined with the economics of health care access, explain why screening rates remain too low. After all, if early detection saves lives with such amazing frequency - again, 98 percent! - why aren't we all doing more to get every woman screened?

The New Mexico screening program asked for a $900,000 increase in its budget next year. All people of New Mexico - men and women - should support this request. We also need to develop culturally appropriate breast health education, screening and treatment programs for Hispanic women and Native women, and we need to recruit and train more women to help all women in New Mexico who are diagnosed with cancer navigate their way through the health care maze.

But most importantly, we need to continue bridging the cultural and social gaps that still exist. While we need to respect traditions and how people live in all corners of our state, respect for life now means that we should embrace mammograms and early detection.

Nellie Sandoval, Navajo, is a 19-year breast cancer survivor and member of the Susan G. Komen for the Cure's American Indian/Alaska Native National Advisory Council.