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Mammography, Sorting Out the Confusion, Part 1

Are you feeling confused by the ongoing debate about mammography? Who isn’t, right?

Mammography has been in the news a great deal of late; but the debate about it has been going on for years now. I have wanted to write about this issue ever since I started blogging, but haven’t gotten around to tackling it until now.

The mammography debate can be quite polarizing. It sometimes seems as if you must pick a side. This is the way we like things; black and white, clear and defined. We don’t like fuzzy, gray areas; perhaps especially when we are talking about issues affecting our health. We expect the medical community to be able to tell us what to do. We want to think we have chosen the right “side.”

Women want to know if they should be having mammograms or not. They want answers.

The trouble is, there is not a simple one-size-fits-all answer. And basically, we have been relying on one-size-fits-all technology, mammography, as our screening tool to provide one-size-fits-all answers. In a nutshell, this is the problem.

Another reason I have not tackled this topic yet is because there are so many facets to the discussion. It’s hard to know where to start. Tackling the topic in one blog post seems too daunting, so I am trying to break it down by putting my thoughts into a couple of posts. And please keep in mind, these are my thoughts. I am no expert.

First of all, it’s important to remember that there two kinds of mammograms. There is the screening version and there is the diagnostic version. For an explanation about the differences, click here.

The debate is about the screening type for the woman at average risk. 

It’s important to also remember that each woman approaches and judges mammography based on her own personal experiences. This is how we make judgments on most, or at least many things we are faced with in life is it not?

If you are a woman whose cancer was discovered by way of a mammogram, then you may well be convinced that a mammogram saved your life. Many women proclaim this very thing as an absolute truth.

However, making such a statement is flawed because these same women will not know if their lives were indeed saved by a mammogram until later. Whether your cancer metastasizes or not (in other words, its biology) more than likely will determine your survival, not a mammogram per se. And an early diagnosed cancer can metastasize later on too, so stating that a mammogram saved your life is sort of premature and potentially inaccurate.

And yet we hear these kinds of statements being said by celebrities or whoever in the media time and time again. It’s not quite that simple. Though important, it’s not all about early detection. We have to face this fact.

If you are a woman who faithfully had mammograms and despite your diligence, your cancer was not detected via that route for whatever reason, well, your thoughts on mammography are going to be quite different.

And if you are a young woman under forty who never had a mammogram because, you don’t need a mammogram because you’re too young to get cancer, and yet you did get cancer, your thoughts will be yet again, quite different.

I started having mammograms around age forty because I was following my doctor’s recommendations and so, mammography became part of my routine physicals around that time. I was, in fact, having my annual physical discussing my next mammogram when my mother took her last breath.

Isn’t that ironic on so many levels?

So the last mammogram I had before the big ‘C’ barged into my life was in 2008. It was normal.

Was my cancer already there, but merely went undetected? Who knows?

When I was first diagnosed, I felt a lot of guilt because I had not had my yearly physical or mammogram in 2009. Among other things, I was busy grieving. This whole mammogram guilt/regret thing is worthy of a post all its own at some point…

Did mammography eventually detect my cancer?

No, it did not.

I was experiencing chest pain. It’s all rather complicated, and no, cancer doesn’t generally cause pain in the beginning, but pain is what got me in the door. I actually thought I was having a heart attack, hence my visit to my local hospital ER. After a few more surprises in the ER, a heart attack was ruled out, but cancer was ruled in, or at least the chain of events leading up to my diagnosis was set in motion.

As I said, I carried guilt “baggage” around with me for quite some time for missing that mammogram in 2009 until one very kind nurse said to me one day, “Nancy, you were actually following the new recommended guidelines for women in your age bracket.” And she was right; I was. And yet I felt that guilt…

Why am I sharing all this?

I’m trying to illustrate that personal experience, in this case mine, is anecdotal in nature. It is not based on scientific experience or evidence.

And it is time to start facing the science regarding mammography.

Stay tuned for part 2. Coming soon!

If you’ve been diagnosed with breast cancer, how was it first detected?

Where do you stand on the mammography ‘debate’?

If you have written (or read) a post on mammography that you’d like to share, feel free to leave a link to it.

 Woman Receiving Breast Exam

 

 

18 thoughts to “Mammography, Sorting Out the Confusion, Part 1”

  1. Thanks for tackling this topic. I was diagnosed with lobular breast cancer in Jan 2014. This type of cancer is generally NOT detected using a mammogram. I felt a strange “ropey” feeling in my breast that was not confirmed by either mammogram or ultra-sound. It took my insistence on a biopsy and a follow-up MRI to confirm the diagnosis. I was shocked when I found out that mammography doesn’t detect all breast cancers. I also think there should be more emphasis on breast self-exam.

    1. Wendy, Mammography does not detect all cancers and your comment is an important illustration of this fact. I’m glad you were insistent and pushed for that follow-up MRI. BSEs are no longer recommended, but of course, familiarity with one’s breasts is very important as is taking note of changes and then reporting them to your doctor. You know this all too well of course. Thanks for sharing.

  2. I look forward to the rest of your series. This is indeed a complicated issue and I know my views are colored by my own complicated experience. What i want to know is: are radiologists given the entire family history background of each patient as they interpret each patient’s image? I wonder if that would’ve made a difference in my case. Knowing my strong family history–would the radiologist have made a different call for me?

    1. Cancer Curmudgeon, It is a complicated issue. I know you had a very ‘complicated’ experience. Mammography certainly has limitations. You raise an interesting question there and I don’t know the answer. I do know it matters who’s reading your mammogram, or rather their skill level matters. Women need to know all the facts and make personalized decisions, that’s the bottom line. Thanks for reading and commenting. Share your link(s) if you’d like. I know you have some!

  3. I just had my 2nd mammogram after being diagnosed with BC last year-they are happy they could see enough but I still have that element of doubt-scar tissue and radiotherapy make it very difficult to see breast tissue clearly and as I still have periods my breasts are more dense despite being on tamoxifen-too worried to take the risk not to have a mammogram-system in my hospital is I have to wait 2-3 weeks after the mammogram for the result-extremely stressful and anxiety provoking having to wait

  4. I too have very mixed feelings about mammograms. The ball started rolling because of a mammogram which showed something in my right breast the ultrasound showed something as well. It all seemed to be vague however the radiologist is the one (who was aware of my awful family history) said we need to do a biopsy but first he wanted a MRI done (I have very dense breasts) That’s how my lobular cancer was found-Two tumors in the LEFT breast. What was seen on the mammogram in the right breast was benign. So my feelings are mixed the mammogram did not show anything suspect in the left but it did start the process toward my diagnosis. I credit the radiologist with perhaps saving my life-time will only tell. My sister-in-law was stage one two years 10 months ago but just last week she went to Stage IV Her cancer was seen clearly on the mammogram but here she is now struggling to just stay alive. I am 20 months out from my diagnosis. I agree with you Nancy the biology of the cancer itself plays a huge roll in our long term survival.

    1. Linda, I’m sorry that both you and your sister have had to deal with a cancer diagnosis and I’m sorry your sister is now stage 4. You raise a very important point in your comment and that’s that it matters a great deal who is reading your mammogram. The skill of the radiologist matters, sometimes a lot. I’m not saying mammograms and early detection aren’t important. They are. But we need to be sure women understand their limitations and risk as well. Thanks for reading and sharing. My best to both you and your sister.

  5. Hi Nancy,

    Thank you for tackling this topic and doing it so well. I can’t wait to read Part II.

    I have mixed feelings on mammography. I know the biology of the cancer really dictates a lot, but if a mammogram did detect the cancer before it might’ve metastasized, then that means something.

    Of course, nobody knows whose cancer will metastasize or be managed with treatment. When diagnosed with cancer, it’s really hard to accept, “Your cancer might not metastasize, so let’s wait and see,” from the doctor. I — and most people — want that tumor removed ASAP. I don’t think there’s enough information to figure out which cancer will spread.

    Back to mammograms (sorry for the ramble, but this topic is near and dear to my heart). A mammogram missed mine because of my dense breast tissue. I found my own cancer through a breast self exam that I did every month. It appeared as a slight dimple on my right breast, and I went to the doctor for a follow-up. A diagnostic mammogram barely found the tumor, but there it was.

    I know some people are against BSEs but I do feel strongly in them because that’s what led doctors to find out that I had cancer.

    Mammograms can be useful tools, I think, and not to be discarded lightly. At the same time, we sort of are in the dark ages if we rely solely on mammograms.

    Great post, Nancy!

    1. Beth, I think most of us have mixed feelings about mammography; I certainly do. They are still useful, especially since they are one of the best tools we presently have for screening. It’s just that they’ve been touted as “supreme” for so long, the shift in how they are perceived is going to take a while to happen. And I don’t think they should be discarded lightly either, but I do wish we had better screening tools. As always, women deserve all the facts. Thanks for reading and sharing about your experience and opinions.

  6. I am one of those people who say that a baseline mammogram, which my doctor at the time insisted upon,saved my life. I was diagnosed 26 years ago. The tumor was small but in a very dangerous place. There was no doubt in any doctor’s mind that by the time I might have symptoms it would have been too late. To each his own – you have to go by your own gut. But I think that until something better comes along I wouldn’t diminish the importance of routine mammos and/or ultrasound. Even getting an extra 5 years of life because of early detection is still saving life.

    1. Geri, It’s reasonable that you feel a mammogram saved your life based on your experience. I agree that sometimes we have to go with our gut and I also agree that until something better comes along we are stuck with mammograms as a screening tool for many women. I am not trying to diminish the importance of routine mammograms; that’s not my intent. There’s just more to the ‘story’ than has been represented for so long. Thanks for sharing your insights.

  7. I think it is an interesting question. I was having the debate myself as my doctor had ordered a screening mamo at my last physical (in January). I’m 43 and just moved to the US from Canada, where the guidelines are different. I was mid-move back in January so didn’t get around to it. Then on June 1st I felt something change in my breast – I examine my breasts every time I get in the shower – at least I used to … now I am just waiting for chemo to start and find it more difficult to examine … but in the end I never had to make the mamo decision, as I found the lump – so my first (and probably only) mamo was one diagnostic rather than screening. Now I go through the debate with the MRI, which has many more false positives …

    1. Rebecca, I’m sorry you are dealing with cancer, but it’s a good thing you noticed something was wrong yourself. Good luck with your chemo treatment. You might wish to read my book. Just a suggestion. Thanks so much for reading and sharing.

  8. Hi Nancy, thank you for initiating this discussion.
    I’m 51 and I’m in Belgium. A mammography showed microcalcifications for 2 years consecutively in my right breast. I was advised to have a biopsy. The biopsy in turn revealed a large zone of DCIS… the surgeon said I should have my breast removed to be safe. That was a difficult decision for me, but thankfully I followed his advice.

    I had a mammectomy with immediate reconstruction (DIEP-flap) and SLN removal. I thought that was the end of it, but unexpectedly cancer was found in the sentinel lymphe node. The removed breast tissue was reexamined and a small tumor of 4.5 mm was discovered. To rule out further problems I have had 12 more lymphe nodes removed (all clean!) and to kill this beast and once and for all I’m currently on EC chemotherapy, followed by Taxol. It’s all very daunting and confusing.

    In conclusion I’d say: yes, mammography helps because it helped reveal a potential problem (DCIS). However, the tumor never showed up.

    1. Katerine, It can be pretty confusing and there are plenty of tough decisions to make that’s for sure. I’m glad your tumor was detected and that you’re able to treat accordingly. Good luck with the rest of your chemo. Do keep us posted. Thanks for reading and sharing.

  9. I recall listening to an episode of IDEAS on CBC podcast back in 2009 – one thing that it talked about was how mammography didn’t improve overall survival, but it did improve 5-year survival – what this really meant was that more women lived with cancer longer … it didn’t change whether or not it would kill you, it just changes how long you had to live knowing you had cancer. In some ways, I’m glad I didn’t find my cancer sooner … had I, I would have had more difficult treatment decisions … having cancer in both breasts means the bilateral mastectomy was a much easier choice than considering amputating a healthy breast … but back to my point on mammography – I’m afraid that had I done the screening mammogram, it would have shown nothing, and I would have had a false sense of security … it was a lump that brought me to my doctor, not a mammogram …

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