Moms, Get Your Mammograms
Kim, Thank you for your feedback and valid insights. I have decided to expand my blog to include some basic…
Even though it is May, not October (when pink ribbons pervade everything everywhere) the topic of mammograms is still important. Certainly to me, as May is my mammo month. But breast cancer awareness should not be reserved for any singular time of year, it should be a regular, habitual occurrence. (I don’t really think there should be specific cancer-awareness-months; every month should be all-cancers-awareness month, but now I’m off-topic).
It’s easy to think breast cancer affects “older women” and most often it does. However, younger women are struck with the disease, too. By younger women I mean mothers of young children…women in their 30’s and 40’s. And these women aren’t anecdotal, faceless cases…they are friends, colleagues and fellow sorority sisters. And if I know some of these women, chances are you do, too.
So moms, we need to get our mammograms. The process may be physically uncomfortable, perhaps we feel a bit embarrassed. Or we are simply scared to make the appointment, afraid of the results. The media, pommelling the public with the graphics of breast cancer has certainly not helped us feel more comfortable about taking this important step in our healthcare. But let’s put it this way: early detection. The sooner a lump is found, the better and more successful the treatment options. And an important tool in the early detection process is the mammogram. You are probably aware of the controversy over how and when this test should be used, but in reality, the mammogram is a good screening tool. Then there is the when- and how-to-do breast exams, which has evolved as well. It’s confusing. The implications of doing (or not doing) either is scary. So let’s reduce the information on both to what you need to know now:
1) When do I need to start getting mammograms? Opinions vary. The American Cancer Society and the American College of Surgeons both agree women should start getting mammograms at age 40 and be screened yearly after that. However, the American College of Physicians and the U.S. Preventative Services Task Force beg to differ: both recommend women start at age 50. The rationale to starting a full decade later? In a nutshell, the reason is monetary. But there are costs more lofty than that: the loss of productivity, of potential and sadly, of parenting. And given the number of younger women I know who have breast cancer, I know I want regular mammograms in my 40’s. And your gynecologist likely feels the same. Get your first (baseline) mammogram at age 40. Then discuss with your practitioner your risk for breast cancer…and agree on a screening plan based on your personal and family health history.
2) Should I do a self breast exam (SBE)? A decade ago, without exception, I taught all my female patients the SBE and told them, absolutely, do it. Now, despite current thinking that SBE has only a small impact in finding breast cancers, I would still say, absolutely, do it. You need to know how your breasts feel and look and the best way to become familiar with “normal you” is to check things out once a month, preferably a week after your period ends (there is less breast swelling at this point in the menstrual cycle). If you know your “normal,” changes in your breasts will be easier for you to pick up on.
3) When should a doctor do a breast exam for me? A clinical breast exam (CBE) is typically done when you go for your annual pap and pelvic exam. Recommendations say a CBE can be done just every three years for women in their 20’s and 30’s, then yearly once a woman turns 40. But reassurance can go a long way…get a CBE every year even if you have not hit the big 4-0. It’s just good, thorough healthcare. And you are going in for your “annual” anyway.
4) I’ve gotten my mammogram…but not my results. Is no news good news? Some medical practices operate under this pretense. That’s not good care. In fact, it is now required of your doctor’s office to send you a letter informing you of your results, no matter what. So if you haven’t heard anything two weeks after you’ve had your mammogram, call your practitioner’s office. Ask to hear the results of your mammogram over the phone and let the staff know you haven’t received anything in writing. Then once you do receive your letter, keep it in your personal records. Because if you should move or need to transfer your healthcare (as with an insurance change), you will want your previous mammograms transferred as well. All the information to do so will be included in that letter.
Every October there is a deluge of media and merchandise to promote breast cancer awareness. Then it all goes away as quickly as it appears. But “don’t forget the pink:” check out this site with some wonderfully concise information for year round breast health:
http://ww5.komen.org/BreastCancer/BreastSelfAwareness.html
I think you present some good information as well as some incomplete data. The preventative services recommendation isn’t as much about money as it is about false negative and false positive testing and all of the risk and anxiety of additional procedures to track down a suspicious mammogram..which are more commonly seen on younger women with dense breasts. Also the radiology groups have a distinct financial gain from recommending mammograms to start at 40 and occur annually.
Next there was a study in China over 10 years ago that trained over 100k women in self exam and there was no significant improvement in early breast cancer detection and no statistical increase in lives saved. Self exam has been linked to more imaging and more radiation exposure for false positive exam.
The law requires the imaging company to alert the patient not the ordering physician or other provider.
Yes. We all know someone who was diagnosed with breast cancer before the age of 50 but there is more to these recommendations than financial gain or rather financial loss prevention on the behalf of insurance companies. Women have been taught to fear breast cancer at such a high level when the bigger risk is heart disease by nearly three times.
Kim,
Thank you for your feedback and valid insights. I have decided to expand my blog to include some basic women’s health care issues, my goal being to bring accessible, concise information into the hands of busy parents. The post on breast awareness is my first in this new category on pulseonparenting.com. Given the controversy and varying opinions on breast cancer screenings, this was a challenging topic on which to begin, especially as I had in my mind both points you articulated on the pitfalls of suspicious mammograms and on SBE. However, I felt detailed descriptions of false positives and negatives and medical studies would have been out of step with my goal and for simplicity’s sake kept with “the basics,” a place to start.
I totally agree with you on the fear women have been told to have regarding breast cancer and this fear can lead to inaction. But some basic knowledge can help motivate women to get appropriate screening. I admit my own emotional bias but as I wish to be a credible resource, worked to keep it in check as I wrote this post. My approach to breast awareness may seem aggressive, which is not because I know someone, a singular individual, who has been diagnosed with breast cancer before the age of 50, but because I know six women who have (some in their late 30’s). These are women I know personally, not as patients, so selection bias doesn’t come into play.
Thank you for correcting me that the imaging center should notify women of their results…not necessarily the practitioner ordering the study. I will be sure to clarify this on my blog. And I am glad you made mention of heart disease…I think it would make an excellent topic for a future post.
Again, I truly appreciate your input on a tough issue.