Tuesday, November 17, 2009

Mammogram News, Too Late for Me

You may have seen the latest headlines in the mammogram controversy, which says that annual breast cancer screenings should begin at age 50, not 40 as previously recommended (perfect bad timing for me, darn it!)

I added the boldface for emphasis:

In Reversal, Panel Urges Mammograms at 50, Not 40

According to the story in the New York Times:
The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year.... While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.
Thanks, docs, for making me endure 10 years of annual and twice-annual screenings that left me bruised, sore, faint, and even bloody. If men needed annual mammograms, the equipment and techniques would have been refined by now to make them painless. For me, a mammogram is excruciating, unless I am in very capable hands. I've actually followed C., my favorite mammogram technician, from one hospital to another, even though that involves a complicated, multi-step process to transfer all my X-ray films and reports.

I once waited more than eight hours to have a mammogram with C., who is a part-time contractor who works only occasional shifts in several hospitals. I've spent hours, over the years, trying to track her down to schedule a mammogram with her via a confused, unwilling receptionist — because C, never causes any pain, and always manages to get very clear images in just the usual six or eight shots. I've sometimes had to endure more that 20 agonizing films with other technicians, which is probably also giving me a hazardous dose of radiation. It wasn't C.'s fault that I spent the entire day in the B-I mammogram clinic; she was scheduled to perform ultrasounds that day, and I had to wait for her shift to end.

As I sat in the waiting room, doing sudoku puzzles, reading, and shivering in my flimsy, faded hospital johnny, I had to periodically fight off the B-I's head mammogram technician, who is the worst I've ever had. She repeatedly tried to cajole, and then bully me into letting her do my mammogram. It was an exhausting day, but worth the time to finally see gentle, reassuring, skilled C. that evening.

I know exactly what the new recommendations refer to as "extreme anxiety." Waiting for any kind of medical test, and then the results, is my worst nightmare — except for actually getting bad news, of course. I don't have a tumor; I have clusters of microcalicifications, a relatively common issue that sometimes turns cancerous. It proved impossible to do a biopsy on them without surgery. But I was spared that: I was sent to the Faulkner Sagoff Breast Care Center, where I was first assigned to C. There, they do special "time-lapse" mammograms, which showed that the microcalcifications seem normal, sparing me from stitches and scars. No wonder I worship her.

Another marvelous thing about the Faulkner is that you get your mammogram report while you're still there. (There's nothing quite like hearing this on your voicemail when you come home at night, after offices are closed: "Hello, this is Beth Israel Radiology. We need to talk to you about your recent mammogram. Can you please call us at your earliest convenience?") I spent that night in shock, wandering the apartment saying, "Oh my god!" about a thousand times. Never again.

With microcalcifications, the standard practice is to "watch" them every six months with more mammography. So for a few years, I went been through weeks and months of continuous, life-ruining anxiety. When retests are scheduled every six months, that's not enough time for me to relax between them for more than a few weeks. Anxiety kept me up at night and greeted me every the morning. It ruined vacations. There was no escape; I didn't see the point of taking an anti-anxiety medication when it wasn't going to make the mammograms go away. When the Faulkner's radiologist told me I didn't need to come back there for a year, I was euphoric for about a month.

I hope these new recommendations spare thousands of 40-something women from similar anxiety and unnecessary testing. But a number of women won't be so lucky: their developing cancers are going to be missed until they are large enough to be palpable. (But the new recommendations no longer advocate month breast self-examinations, either. Go figure.)

In spite of everything I had to go through, I was unbelievably lucky: I didn't have cancer. That's all that mattered. But I can't help wishing that getting there hadn't been so hard.

When I go for my next mammogram in May (by the way, I've actually burned out on long-term dread about these now, and just get nervous a few weeks beforehand now), I wonder if they will tell me to come back in two years. Heck, I wonder if I should call them to reschedule for 2011 right now!

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