Yesterday was the last day of October, breast cancer awareness month. Women (and men) of all ages can get breast cancer and ultimately, right now, 1 in 8 women WILL get breast cancer. That’s 12.5% of all women. It’s a big deal. And that’s why we have pink ribbons, an awareness month that everyone knows about, walks and races for the cure, etc.
And yet, there is no consensus on the best screening recommendations. At what age (if any) should mammograms start? How often should they be repeated? Is 3D better (or just more radiation)? If you have dense breasts, should you be told (yes!) If you have dense breasts, should you have a screening ultrasound in addition or in place of a mammogram? Or maybe an MRI? And how about doing a BRCA test? It gets really confusing! And the national health organizations don’t agree:
As for me, my maternal grandmother had breast cancer in the 1960’s, had a mastectomy, and lived another 20 years. I also have dense breasts, which raises my risk of breast cancer. But, overall, since I live a healthy lifestyle, my risk remains in the average category. So, when I turned 40, I followed the then current guidelines of having a mammogram every year or so and was relieved when they came back negative.
About 8 years ago, I had a mammogram and it showed something suspicious, so the radiologist asked me to stay and have an ultrasound too. So I did, worried, but not too freaked out. The ultrasound still looked suspicious, so they wanted me to have a biopsy the following week. That was, of course, more stressful, and having to wait a week to have it meant I spent the week worrying if I had breast cancer. The biopsy itself was uneventful, and the women who worked at the radiology center were amazing. But, I still had to wait to get the results of the biopsy.
Another several days of waiting and we got the pathology report which was equivocal. The radiologist (who specializes in breast biopsies), thought it was benign, but wasn’t certain because aspects of it were suspicious. She recommended excising the mass to be sure. The options were to go to the hospital and be put under general anesthesia, or have it done under local anesthetic in the surgeon’s office. I opted for the latter. That required a visit with the surgeon to discuss, and then a return visit the next week for the surgery. At this point, we are almost a month from the initial mammogram and ultrasound, so several weeks of anxiety.
I go in for the surgery, earbuds and music equipped, so I can endure the surgery without dwelling on the procedure. After cutting open my breast, which was painless, the surgeon starts cutting further to get to the mass. And suddenly, the anesthetic no longer works. I start saying “that hurts”, and I thought he put in more medication and he continues cutting, but the pain doesn’t diminish. This is the worst pain I have ever felt, and my entire body is shaking in pain. My arms are loosely tied down and I don’t want to have him make a mistake, so I try to stay still, but I continue to say it hurts and shake. With the earbuds in and music on, I can’t tell if he says anything to me, so I just bear it. Finally, it is over.
I don’t know what to say to the doctor or nurse after I am dressed again. They give me the post-op instructions and a prescription for pain meds, and I walk out to my car and burst into tears. I never fill the prescription because the pain I feel afterwards is nothing compared to what I felt during the surgery, and I don’t really want an opioid. But, everytime I lie down to sleep, I relive the surgery and the pain. It takes several weeks for me to get over that. I also couldn’t face going back to the surgeon for the post-op check, so I ask my primary care doctor to do that. I did write a letter and the surgeon writes back denying hearing me complain or seeing my body shaking in pain.
Fortunately for me, the final biopsy came back benign, and my breast cancer scare was over for the time being. How much worse would it have been if I had had to go through more treatment and fear after that horrific procedure! I am so grateful I didn’t have to find out. I have many friends and relatives who have had to go through breast cancer treatment. It might not be as physically painful, but the emotional torment is horrendous. My sister-in-law tragically died from breast cancer. I know how lucky I am.
Are False Positive Results Justified?
So my point is not to bemoan my bad luck, but rather to show that oftentimes, screening mammograms bring about a lot of anxiety and pain, even when it turns out that everything is fine. According to the Komen Foundation, the chance of having a false positive result after 1 mammogram ranges from 7-12 percent, depending on your age (younger women are more likely to have false positive results). After 10 yearly mammograms, the chance of having a false positive is about 50-60 percent. This would be acceptable, perhaps, if having screening mammograms resulted in less death from breast cancer.
Mammograms are frequently talked about as being a preventative measure, but of course, they are not. They screen for cancers that are too small to be felt, but are already growing. We know that the incidence of breast cancer has gone up. The question is whether finding tumors earlier, and then treating through surgery, chemotherapy, and/or radiation results in fewer deaths from breast cancer. Death rates from breast cancer have gone down over time, but is that because of mammograms, or because we have improved cancer treatment? A major Danish-Norwegian study completed last year was designed to answer this question.
A Population-based Cohort Study in Norway
The researchers followed all Norwegian women aged 30-89 and identified those who developed breast cancer in the period 1987-2010, before subsequently comparing the number of deaths before and after screening mammograms were introduced. Associate Professor Henrik Støvring from Aarhus University, Denmark, notes, the result does not favor the breast cancer screening use of mammograms. “The important result is that we do not find a beneficial effect of breast cancer screening any longer. The original randomised trials examining breast cancer screening were conducted way back in the 1980s, and they showed an effect, but the fact is that the better the treatment methods become, the less benefit screening has.”
Nevertheless, all American medical organizations still recommend mammograms, as noted above. And it is only one study, though a large one, and in Europe. Still, it does make it hard to know what to do, and for now, I will likely still continue to get mammograms although definitely not yearly. My family physician recommends that I get a mammogram every 2 years . The last time I had a mammogram, in late 2017, there was a suspicious lump which was confirmed with ultrasound in the same area as the original mass. It was taken out again (with much less trauma, but still stressful) and was found again to be benign. I will go in for a breast ultrasound next week, but I am not currently planning on getting a mammogram this year.
I heard that CBS morning news anchor, Gayle King, said that if men had to have their penises squeezed painfully every year or two, they would find another way to screen for penile cancer. While the physical reality of having a mammogram isn’t pleasant, the emotional pain and anxiety that can follow a false positive result is much more severe. The purpose of this post isn’t to bash mammograms; they do find cancers and, at least some of them, are cancers that are likely better off being found sooner rather than later. But, they no longer seem to decrease breast cancer deaths (my sister-in-law had had a mammogram within a year of her initial diagnosis). So I think Gayle is right: we need to find a better breast cancer screening tool than mammograms. But for now, I will try to do the things that I know help prevent cancer, and I will continue getting mammograms periodically, meditation tools in tow!