Angelina Jolie’s recent essay about choosing to have a double mastectomy to circumvent breast cancer gave women a lot to think about. I don’t know about you, but it terrifies me that extreme pre-emptive strikes like hers — as in electing to remove body parts before actually being diagnosed with an illness — seems to be the future of medicine.
Jolie explains that she tested positive for a “faulty” gene, which doctors estimated put her at very high risk for breast and ovarian cancers. Surgery, she said, greatly reduced her odds of getting sick, at least from anything having to do with her lady parts. Does that mean that every woman with a history of cancer in her family should get a DNA test? Thanks, but I’ll pass. Because, honestly, if the world’s most beautiful woman has somehow lost the genetic lottery, the rest of us are doomed.
Well, maybe not all of us. The general odds of getting breast cancer aren’t quite so dismal. One in eight women in the U.S. will develop invasive breast cancer over the course of her lifetime, according to BreastCancer.org. It’s often highly treatable, especially when caught early on. And, although breast cancer death rates among women in America are still higher than those of most other types of cancer, they’ve been declining for more than a decade. The number-one killer of women nationwide is heart disease.
Jolie’s surgical route isn’t the only way to stay alive. Women can play a major role in our own health simply by conducting monthly self-exams and scheduling routine screening mammograms. The National Cancer Institute generally recommends a mammogram and a clinical breast exam — as in, one conducted by a health care provider vs. a self-exam — once every two years, starting at the age of 40. Non-federal experts suggest you wait until you’re 50, unless your personal circumstances warrant otherwise. I have a history of breast cancer in my family, so I chose to start on the early side.
Mammography, even at its best, can be an uncomfortable experience. You’re naked from the waist up, letting a stranger manhandle your boobs. (Tip: Don’t even wear any deodorant or talcum powder, because it may contain traces of aluminum.) The first time I got a routine check, at age 40, I was also paranoid that the technician would find something wrong. My self-inflicted trauma was amplified first by her insistence on clamping my 36DDs down so tightly in the X-ray machine that they hurt, and then by her reluctance to show me the images of my breasts she was seeing on her computer screen.
Seriously? As a woman, hadn’t she ever been on the receiving end of mammogram? I concluded that either something must be horribly wrong with me or the threat of a malpractice suit weighed more heavily on her decisions than the needs of her patients. Either way, I wanted to cry. Later, her complete lack of bedside manner made me angry. If this is how other women get treated by female medical professionals at a major breast cancer center, it’s no wonder that mammography rates are hovering around 54 percent.
I dreaded getting another mammogram after that. But, instead of letting the terrorists (the technician and my self-consciousness) win, I changed providers. My past two trips to the lab have been entirely sane and humane, and I’ve felt way more comfortable. However, the experience can still be a bit surreal: During my most recent X-ray session, the technician taped a tiny metal bead to each of my nipples. When I asked her why, she replied, “So the doctor who examines your film can find them.” Right. Are they in an unusual place? I wondered, thinking that perhaps gravity has been less kind to my 44-year-old breasts than I’d realized. But, in the end, they didn’t detect anything abnormal, which my OB/GYN later confirmed. Whew.
Women who choose to get screened — and I hope everyone reading this will — have some options, depending on what their doctors will support and insurance or personal bankroll will cover. A routine screening mammogram (the kind you get as a control measure when you have no signs of trouble) produces four X-ray images of your breasts, or a front and side view of each one. If this screening detects anything amiss, or if you or your doctor finds a lump during a physical exam, you’ll want a diagnostic mammogram, which orders up more images, including some from additional angles. You may also get a breast ultrasound, which helps physicians tell the difference between a tumor and a cyst; or a breast MRI, which provides other supplementary tissue-related information, particularly in high-risk patients.
According to the Johns Hopkins Breast Center, approximately five to 15 percent of women having a screening mammogram will be asked to return for additional imaging. If this happens to you, don't panic — as the center points out, the follow-up imaging usually produces benign results.
Mammogram costs can vary wildly, from about $100 to more than $2,200, so it pays to shop around. Can’t afford one or lack insurance? The National Breast and Cervical Cancer’s Early Detection Program can help you find free and low-cost screenings in your area. It may be helpful to note that, in most states, you’re now legally entitled to screenings.
Like Jolie, I’ve lost loved ones to breast cancer, and I also know quite a few survivors.This includes my 94-year-old grandmother, who’s recovered twice in her lifetime. She’s now in a nursing home, coping with Alzheimer’s. Selfishly, I’m glad she stuck around; I feel fortunate that I got to know her as an adult. The past year, however, has been truly heart-breaking. “This is hell,” she cried during my last visit in February. Yes, it is. But, sadly, dying is an inevitable part of being human that none of us can avoid.
My grandmother’s story, as well as Jolie’s, certainly have given me a lot to think about. The only conclusion I’ve come to so far is that getting a mammogram is far less scary than other preventive measures — and cancer. So, I’ll keep getting them. How about you?