Breast Cancer Awareness: A Casual Conversation About Mammograms

In fact, this sticker is inaccurate. I got my 3D tomosynthesis-assisted mammogram a week ago. As I am wont to do, I wore my employee ID badge, identifying me as a clinician, to the appointment. Perhaps for that reason, or perhaps because of my breast cancer history, or perhaps because the mammographer called in one of her colleagues to check that she got all the images she needed to, I got to watch the computer monitor as they scrolled through the digital images that had just been taken of my breast-and-a-half. None of us saw anything alarming, but what do we know? Well, as it happens, we know a lot, but the radiologist has the last word. I was pleased that the misshapen lump that is what’s left of my right breast was utterly without density. And the left breast appeared to have only “scattered areas of fibroglandular density.”[1] This is a change from a few previous mammograms, which had shown that my breast-and-a-half was getting denser. Okay, I’m not a radiologist, but I was glad to see that my breast tissue seems to be trending toward less density, after trending toward more. Who knows why, but I do take vitamin D3, which has been associated with decreasing breast cancer risk, possibly by a mechanism which reverses breast tissue density.[2] So perhaps after taking a lot of it these past few years, it’s doing something.

Anyway, bottom line is the thing was negative, according to the damned report I finally got a week later, after hectoring my poor primary care doc, then driving to my local hospital and getting a copy of it, plus a disk with the images, from the nice diagnostic imaging clerk. The nice clerk, after reading my ID badge, which identified me as a clinician, and looking at the computer, which identified me as a person with a breast cancer history, initiated an interesting conversation. I will paraphrase it as follows:

She: You know, these 3D things are pretty good, but why don’t we have a better method for detecting breast cancer than mammograms?
Me: I know! Mammography is so last century.
She: And what about all that radiation? I mean, this woman comes in who’s 70, who’s had all these mammograms, and the current mammogram is negative, and she says, “But I can feel a lump,” and then she gets an ultrasound that finds out she has breast cancer. Come on! After all those mammograms that didn’t find anything? What’s up with that? And you have to wonder if all that radiation caused the damn breast cancer after all those years.

(The jury is still out on this subject, by the way, but here’s a quote from the National Cancer Institute[3]: “Radiation-induced mutations can cause breast cancer, especially if exposure occurs before age 30 years and is at high doses, such as from mantle radiation therapy for Hodgkin’s disease. The breast dose associated with a typical two-view mammogram is approximately 4 mSv and extremely unlikely to cause cancer. One Sv is equivalent to 200 mammograms. Latency is at least 8 years, and the increased risk is lifelong.” But to continue…)

Me: No kidding, huh? Way too many lesions are missed by mammograms, no matter how fancy they are.
She: I think everyone should at least get a breast MRI, say, every five years, no matter what. But then, that would be MORE radiation. It’s nuts.
Me: I know, I know! There are some blood tests being developed, but who knows how long it will be before they are reliable and available.
She: It’s crazy. And that 70-year-old woman? They were ready to send her home after that last mammogram, and she had to insist that she get some follow-up. I had to call the ultrasound person and get them to see her right then. And they said that the cancer had probably been developing for years. Years!
Me: And then we have Pinktober, which is all about corporations selling pink crap and making money, and here we are in 2015, still stuck with outdated detection technology. Not to mention that up to 30% of women who’ve had breast cancer will develop metastatic, stage IV breast cancer. Is 30% of the research on breast cancer going to stage IV? No! And men don’t even know to get screened, and by the time they do, well…
She: I know! We had a man come in, whose sister had breast cancer, and it never occurred to him that he might be at risk, too. And then he found a lump…I told him, if your sister has breast cancer, and you’re her brother, then, you’ve got to get checked.
Me: Yeah, not to mention BRCA genetic mutations. They’re carried by men and women.
She: And why don’t doctors who have patients who smoke cigarettes make sure they get a regular chest X-ray? We have all these women getting mammograms, that don’t work sometimes, and here’s these people who are at risk for lung cancer, and they never get a chest X-ray! Totally crazy.
Me: Yes, it is.
She: Well, here’s your report and your disk. Do you need anything else?
Me: No, I’m all set. Thanks very much.
She: You’re welcome. Nice talking with someone who has a clue, you know? I don’t get to have this kind of conversation very often.

1. ACR BI-RADS® ATLAS — MAMMOGRAPHY. Report with images on interpreting breast density.
2. Cancer Causes Control. 2012 January; 23(1): 1–13. doi:10.1007/s10552-011-9851-3. Vitamin D and mammographic breast density: a systematic review.
3. National Cancer Institute, physician PDQ on breast cancer screening. Scroll to section on ‘Harms’ of mammography.

This entry was written by Kathi, posted on Wednesday, September 23, 2015 at 01:09 pm, filed under Radiation, Screening, Survivorship and tagged , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

4 Responses to “Breast Cancer Awareness: A Casual Conversation About Mammograms”

  1. Fascinating conversation!

    MRI doesn’t involve ionizing radiation like 2-D and 3-D mammography does, and it has more false positives, but its definitely another approach to dealing with detection issues especially in young and high-risk women. The fact that she rarely has such a conversation is telling. It’s just what that good doctor said on NPR, “period, end of discussion” when rational and evidence-based DISCUSSION is what is sorely lacking. Mind boggling.

  2. I know, Gayle. Very telling. Also heartening. This woman is not a clinician, but she’s obviously been paying attention. Gives me hope that at least some folks ARE paying attention.

  3. Wow, that about says it all about the craziness of it all. Nothing to add except … congrats on decreased density?

  4. Really noticeable decrease in the density, Eileen! Yay.