The mammogram debate continues. Eleven things to discuss with your doctor.
Despite the frustration it causes, I’ve heard it said that the ongoing mammogram debate is actually a good thing. Debate and discussion facilitate more debate and discussion. More debate and discussion eventually facilitate (hopefully) change and improvement.
Without debate, change and improvement happen even more slowly, if at all.
So while frustrating, the mammogram debate will help to eventually (again, hopefully) bring us to new and improved methods of more personalized screening. But until we get there, the frustration for many continues.
To read more about mammograms from a personal angle, mine, click here for part 1 of this series. For some basic facts on mammograms, click here for part 2.
It’s important to not throw your hands in the air and say, I might as well do nothing. Doing nothing is not the answer either.
So, what’s the woman of average risk to do?
For starters, ask questions.
Asking more questions results in gaining a better understanding. Gaining a better understanding enables you to make better informed decisions. Better informed decisions always trump those based on fear, inaccuracies, incomplete information or anything less than full disclosure.
Any sound decision first requires receiving, deciphering and then understanding available information.
But even then, the confusion lingers because again, there is no one-size-fits-all answer for all women.
The bottom line is that each woman needs to have a frank discussion about mammograms with her doctor and ultimately make the choices that she feels are best for her.
Easier said than done, of course. It usually is, right?
Though mammography is an imperfect tool, it’s still the most readily available screening tool available, and we are stuck with it until better ones come along. But, there are definitely some questions to think about and ask your doctor before your first or next mammogram.
11 things to discuss with your doctor:
1. Your family history of breast cancer (if there is any) and be sure to discuss both sides of your family tree. If there is a hereditary cancer component in your family history, that’s a whole different ballgame.
2. Breast density matters. Have a discussion about whether your breasts are dense or not and what it means for you if they are.
3. Find out what other screening options are available, such as digital mammography and 3-D breast imaging, and if they are appropriate for you or not. MRIs and ultrasounds might also be discussed for some women.
4. Ask who will perform your mammogram and find out how much experience the individuals doing the test and reading the results have. Who is interpreting your results matters, sometimes a lot. Find out if your facility is FDA certified.
5. Find out exactly what a mammogram “looks” for.
6. Ask to have BOTH the risks and benefits of mammography explained to you. You deserve to hear both.
7. What are YOUR preferences. How do you feel about the potential risk of being over-diagnosed and/or over-treated? Or likewise, missing a diagnosis because you opted out of screening. How much risk either way are you comfortable living with?
8. Ask your doctor where he/she stands regarding mammograms for a woman of your risk in your age bracket.
9. Find out when you’ll get results, how long it takes to get them and how they will be explained to you.
10. Find out what happens if your mammogram finds something. What happens next?
11. Ask anything else that you are wondering about and don’t be put off.
To read the American Cancer Society’s screening guidelines click here.
For Mayo Clinic’s screening guidelines, click here.
To read the updated U.S. Preventive Services Task Force recommendation statement for screenings, click here.
Again, it’s worth stating that there is no one-size-fits-all answer for all women. Mammograms are imperfect, but they are what we have. We need better options, but until then…
Without a doubt, our current screening methods for cancer of any kind (and treatment methods) will some day seem archaic. I wonder what the future holds…
I envision a machine a woman (or a man) could simply walk through, sort of like the TSA scanners at airports. I envision such a scanner detecting any suspicious cellular activity, sounding an alarm and directing the person to machine number two where any suspicious cancer activity would automatically be deactivated or simply zapped out. The person would then walk out of that machine as good as new and go about her business.
No need for slash, burn or poison. No need for a major life disruption.
There would be no more suffering from breast cancer, or any other kind, and certainly no more dying from it.
Just a hopeless dream?
Who knows?
Today’s dream might be tomorrow’s reality.
What a lovely reality that would be.
For now, the mammogram debate continues.
What would you add to the list?
What is your position on the mammogram debate?
Sign up for emails/newsletters from Nancy’s Point here.
Beth L. Gainer
Wednesday 9th of July 2014
Hi Nancy,
I'm not anti-mammogram either, but I think there's a real lack of better screening tools. And #2 on your list -- the part about dense breasts -- really struck a chord with me. That's why a mammogram missed my tumor. Unfortunately, at the time, nobody was discussing dense breasts. It was on the report, along with my "negative" status, which of course turned out to be untrue.
Excellent post on an important topic.
Nancy
Wednesday 9th of July 2014
Beth, Thank goodness breast density is now being discussed. What took so long? That's what I'd like to know. And yes, we do need better screening tools; we can all agree on that. Thanks for reading and for the tweets too.
Cancer Curmudgeon
Thursday 3rd of July 2014
Great timing with this list--I was able to send it to someone in need of it! I commented on the first part of your series and in your response you said I may put a link to one of my posts about this issue: http://anotheronewiththecancer.wordpress.com/2014/03/11/get-there-faster/ My views remain the same. I'm not in the "mammo saved my life" mindset, nor am I all that opposed. I just want something better, NOW. I am tired of hearing that mammos, or other tests for that matter, are not that useful without hearing suggestions for something better (there is a similar discussion about screening methods for thyroid and the recent articles about the usefulness of pelvic exams come to mind).Perhaps the public would not cling to less-than-useful tests if there were better options. THAT is a message I'd like folks studying and reporting on screenings to get: pointing out problems without proposing solutions frustrates the audience - I know, I do it all the time!
Nancy
Friday 4th of July 2014
Cancer Curmudgeon, I'm glad you were able to put my list to good use. I hope the person you sent it to finds it helpful. I want better screening tools now too. And like Ann mentioned, I want more research on what causes metastasis, among other things. And then there is the whole prevention angle. Yes, there's a lot to be done. Thanks for sharing what you think the message should be and for sharing your link too.
ButDoctorIHatePink
Wednesday 2nd of July 2014
Great, informative series. Many people think I am anti-mammogram, but I am not. It is still the best screening tool we have. But it is not perfect, and the hype is way beyond what the tool deserves. Many women confuse having a mammogram with saving a life, as we all know from those newswomen who do it on national TV.
In many cases, it can find cancer early enough to be treatable, but in many cases, it doesn't matter. I was one whose cancer was found early, did my treatment, and cancer spread to my liver anyway.
But I would rather not anybody go through what I have and some women are able to find it early enough to prevent metastases and so they should.
What we really need is more research into the mechanism of metastases so we understand which cancers, once found, will spread anyway, and which won't.
Everybody should make an informed decision and you have helped them do it.
Nancy
Thursday 3rd of July 2014
ButDoctorIHatePink, I am not anti-mammogram either, but the benefits have been over-hyped for years. Informed decisions are always the best. And the bottom line is the death rate from metastatic breast cancer has not been changing much. I agree completely with your statement about research/metastases. There is a lot of work to be done in a lot of areas. Thanks for reading and commenting, Ann.
Sue A
Wednesday 2nd of July 2014
I am one of those people who makes their doctor crazy. I never had a screening mammogram - found my lump myself, and had follow-up diagnostic mammograms for 5 years, but now that they say it's safe for me to go back to screening mammograms, I don't go. I know this sounds weird - but it doesn't seem that mammograms save lives (death rates aren't down, while diagnoses are way up), so why bother? Why expose myself to extra radiation? My breasts are so not-dense since several years of tamoxifen, I can feel all the structures in them. I knew what cancer was the first time.
None of the doctors I have ever talked to ever say anything except follow the standards. They might as well be machines, why bother?
Nancy
Thursday 3rd of July 2014
Sue, Your comment doesn't sound weird at all. It's an important point I'd say. Early detection is not the whole story and this "not telling the whole story" has been and continues to be a problem. And you're probably right, most doctors do just follow the standards. That's fine, but you can still ask the questions and see if they have opinions of their own they're willing to share. If they don't like to talk about this, or whatever you're wondering about, I think that's a problem. Thanks for reading and sharing.
Gail Speers
Wednesday 2nd of July 2014
Great info Nancy! I have a comment on point number 4. Certainly one should ensure they are being tested at an accredited facility. Beyond that I think asking who is going to do the test and who will interpret it and inquiring as to their qualifications is (a) hard to do; (b) likely to be off putting to the people you most want to be on your side. I'm Canadian, I would not do what you suggest in point 4. But perhaps that is more normal in the US. Good work on the mammogram trilogy. I like your fantasy machines... I hope that is what the future holds!
Nancy
Thursday 3rd of July 2014
Gail, I don't think there's anything wrong with asking the person who's doing your mammogram how many she/he has done. Nor do I think it's offensive inquiring about the credentials of who will be reading the results. I think this is totally fine to do. But you're right, some might not be comfortable asking. Thanks for reading and commenting.