Mammography & Me (or no longer me)
Posted November 18, 2009on:
Add a third reason that makes this is a very strange time to have breast cancer. The first was the health reform that has been so twisted that some have claimed “death panels” will decide who will live and die. Baloney. These false claims are simply mean spirited and evil.
Then, there’s the H1N1 virus, a name that was given to protect the identity of swine who might have been the link of this influenza to humans. A person can feel paranoid leaving the house, particularly if your immune system is compromised.
The third comes from the recommendations from the U.S. Preventive Services Commission that women should not have routine mammography until age 50 and then every other year after that.
I remember a time when I heard 1 in 11 women will get breast cancer in their lifetime. Now it’s down to 1 in 8. Growth has come in the younger women, who face more virulent cancers. Since my diagnosis, the number of young women with cancer – before menopause – have astounded me. For most, their tumor was found by a mammogram. Many of them have young children.
Early breast cancer is such a problem in the Jewish community for those of Eastern and Central European descent (Ashkenazi Jews), that there is an organization dedicated to those women, www.sharsheret.com. (Being post-menopause, I am not a young woman with breast cancer.)
I recognize that women who are of high risk because of family, ethnicity or something else will be followed earlier and more carefully despite these recommendations. But how easy will it be for insurance companies to stop paying for annual mammograms in young women to save money? Or, at least to reject payment initially hoping you’ll not appeal? That happens all the time.
One gift of having chosen to have a double mastectomy for a cancer in a single breast is that I don’t have to worry about mammograms for myself. However, as I have said several times, it ain’t all about me.
I shudder to think of those women in their 40s who decide they don’t need a mammogram until age 50. Or for women in their 50s whose cancer develops between those two years of mammograms so they are diagnosed at a later stage.
I did have regular mammograms. I did self-exams, not perfectly, but did them. I thought what I felt in my breast to be connective tissue. My own cancer was hiding within a normal-looking cyst. It wasn’t supposed to be cancer. As a result, my cancer was not diagnosed early – it’s stage 3A. It’s still treatable but with big guns. And those guns are very big and overwhelming. And tough.
One argument for later mammograms is that it will mean fewer false positives, leading to anxiety related to follow-up testing, including biopsies. I would much rather have had a couple false positives and maybe diagnosed at an earlier stage then to let a tiny cancer grow large before it is found.
The anxiety is very real before each mammogram, but nothing feels better than hearing it is OK. Women are terrified to be called back but if ultrasound and/or a biopsy finds there is no cancer that is reassuring in the end. As I understand it, the commission was concerned about the anxiety from these tests. It sure is better to know than to not know.
And I have to tell you that the greatest anxiety for me was in the diagnosis process. Once I knew I had cancer, I immediately felt better. That may sound odd, but I moved into action mode. The unknown was much more difficult for me than the known.
One reason for raising the age because women are exposed to radiation through annual mammograms, so the answer is to continue to improve the technology. I grew up in an era where there were x-ray machines in shoe stores. They were supposed to make sure we had the right sized shoe. Of course, kids exposed themselves to tons of radiation playing int he machine.
A bit of annual radiation seems to be a worthwhile risk if we are talking about your wife, mother, sister, aunt, cousin, friend or yourself.
In the end, if this recommendation is embraced despite opposition from many cancer authorities, it will be another way for insurance companies to get between us and our doctors. And to save money at the expense of lives.
It may also be short sided financially. I know my cancer care is more expensive because of more treatment needed at a later stage.