The 20-Year Mammogram

I have a close female friend who is highly educated on the graduate level, but she was born and raised in the agricultural Midwest where preventative medicine is not a common meme.  Her last mammogram was 20 years ago.  She shared the story of her latest breast exam with me so that I might share it with you now.  There are three reasons why she waited so long between mammogram.  One, they hurt too much.  Second, there’s been some research suggesting regular mammograms may not be helpful.  Finally, they hurt way too much to get every year!

I can try to understand the mammogram pain — especially in the bilateral views where they not only squeeze your breast downward between two plates, they then squeeze it sideways between two plates, too.  We men nod our heads as we try to understand that sort of squeezing pain, but I’ve never met a woman who enjoys the discomfort of the mammography radiology process.

The modern science concerning the necessity of mammograms is confusing:

Upon completion of the first six randomized mammography trials in 1989, the American Cancer Society, the National Cancer Institute (NCI) and various other organizations issued joint recommendations for women aged 40–75 years. Subsequent analysis, however, demonstrated negligible benefit in the 40- to 49-year-old subgroup. This was in striking contrast to patients 50 years and older, for whom an overall 25–30% reduction in breast cancer mortality was observed. In 1992, Canadian investigators reported no significant benefit for mammography in women aged 50–59 years and a statistically insignificant excess of breast cancer mortality in the mammography group in women aged 40–49 years.

In America, mammograms are plummeting in popularity:

According to these researchers, there has been a decline in the number of women 40 to 49 getting mammograms. That means patients are listening and making decisions based on their individual health characteristics and risk factors.  This is what you want people to do when the science gives them choices.

My friend’s GYN was horrified to learn it had been 20 years since her last mammogram and pap smear, “Back when you didn’t need them;” and my friend was promptly admonished for not being preventative, “This is New York, not the Midwest.  We go to the doctor here.”

The fact that my friend has breast cancer in her family history didn’t help assuage her doctor’s concerns and a pap smear and a mammogram were immediately scheduled because my friend was experiencing pain beneath her right nipple.

When my friend went in for her mammogram, the nurses said they were pretending this was the first mammogram of her life and planned to be very thorough.  They discounted the only mammogram she had 20 years ago.  They bilaterally scanned both breasts and did an intensive ultrasound on her right breast — the whole process lasted 2.5 hours.

Everything, so far, seems fine, but they did find a cyst in her right breast that was likely causing the nipple pain.  Instead of going back in a year or two for her next mammogram, she’s scheduled to go back in six months.  I think the doctors want to track the life of that cyst to see if it shrinks or gets larger.

I don’t know if cysts in breasts are commonplace or not, but I’m sure having a cyst in your breast makes any sort of pressing that breast between two radiological plates a really uncomfortable experience, and it’s too bad there isn’t a less painful way for women to make sure their breasts aren’t killing them.