There is a lot more to it than thumbs up or thumbs down. There are a variety of issues like lifetime radiation loads, false positives, false negatives, the skill of the radiologist, the quality of the equipment, and whether you are pre- or post- menopausal.
Honestly, I didn't pay a bit of attention until I got a call in the summer of 2008, letting me know that an abnormal axillary lymph node had been seen on my mammogram, and that I needed to come back in for a second look.
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| Not a Kitchen Aide Stand Mixer |
Stats about all the important issues raised above never entered my universe. While data is crucial, I think that the power of the story has the potential to have a great impact.
Here's one.
When I was 40, I dutifully had my mammogram and got the all clear. When I was 41, I got my second one and got called back, as I mentioned above. When I returned, I had a series of diagnostic mammograms, which were more focused and read by the radiologist while I waited. My breasts passed muster, but the lymph node was concerning. I went from ultrasound to a fine needle aspiration of the course of a few weeks, then I got that phone call that people are talking about when they say we're all one phone call away from our knees.
The doctor told me that there were malignant cells in the node, but that it wasn't breast cancer. They were squamous cells. The doctors were befuddled. I was flattened.
So I got a second opinion. They did another biopsy and said the nodes were clear. They sent me for a breast MRI which came back highly suspicious for breast cancer. They recommended that I have the breast and all the nodes removed.
So I got a third opinion. They removed that node and 5 others, froze the suspicious one on the spot and determined that I had Invasive Ductal Carcinoma, the most common form of breast cancer. The breast MRI estimated the tumor size at 5 - 8 cm, too large to be removed surgically. I had chemotherapy first to shrink it, then had it removed along with the rest of my breast and the left one too. Surgery was followed by radiation. I also had a full year of Herceptin.
What about the squamous cells and the possibility of a rare cancer? My third team told me that those fine needle biopsies can only say malignant or non-malignant, they can't accurately identify the type of cells. I spent more than two months chasing that ghost before I learned this.
What about the biopsy that was clear? The third team told me that nodes are tiny and move around. They probably missed.
Here we are. I'm 3.5 years down the road from when this mess started and people ask me what I think of mammography. I tell them to pull up a chair and make themselves comfortable.
1) My first and second screening mammograms missed a HUGE tumor. My surgeon (third team) said she could see it in the first mammo when I turned 40, although the image was of poor quality. The diagnostic mammos missed it too.
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| The Real Squamous Cells |
3) At the same time, if they hadn't caught the node in my mammo, I'd likely be dead right now. The cancer was clearly on the march, having already invaded one local node.
4) Mammograms are often described as being the best prevention. They are not prevention. They can only detect a cancer that already exists. That's not prevention.
5) That said, mammos are our current standard of care. It's important to know, however, they are much less accurate in pre-menopausal women because of dense breast tissue.
Not a black, white, or pink answer, but it is the truth.
My truth.
Caution is definitely in order when deciding on mammograms. Talk to your doctor. Most of all, if you are uncomfortable, seek second, third, or tenth opinions.
