by: Lynn Roodbol

Copyright 2005 Cancer Support Coach

There are so many jokes about mammograms! Have you heard the one
about the fridge door …or the bookends …or the garage floor? Thanks
to all the jokes, “Mammogram” has become a household word, and it’s
not that I don’t have a sense of humor, but as a mammography
technologist, I’ve heard the jokes many times. I think the jokes are
embarrassing for women and demeaning with regard to their physical
bodies. Many women say, “If men had to do this, there would be a
better solution” - this may or may not be true. Most people agree
that mammograms are not perfect, but until there is a better
solution, I think it’s time to look at mammograms in a different
light.

In May of 1985 and 1986 I asked my doctor to order a mammogram for
me and he refused both times saying I was too young. There were no
screening mammography centers to which I could refer myself, so that
was that. In December of 1986 at the age of 42 I felt a lump in my
breast and had a mammogram the same day. It turned out to be Stage
II breast cancer with 4 positive lymph nodes. I had a lumpectomy, a
mastectomy and chemotherapy but chose not to have radiation. I
obviously wasn’t too young to have cancer.

In May 1985 a mammogram cost less than $60.00 and would have
resulted in my having minor surgery to deal with a small lump.
Delaying the diagnosis until December 1986 raised the cost of the
medical care I received both in dollars and the amount of human
suffering we faced. I say “we” because a diagnosis of cancer affects
the family, friends and community of the person with the disease. A
timely mammogram would have saved us all a lot of grief.

The common perception is that having a mammogram is a negative
experience; I think this is a bad rap. Mammograms are quick and easy
breast X-Rays; which usually means two views of each breast – one
from the top and one from the side. They are performed by friendly,
knowledgeable technologists who do their best to help women feel at
ease. The technologists’ goal is to get the best films possible and
also to make the experience as quick and painless as possible.

When people go for a mammogram the most important thing to know is
that relaxation of the upper body is the key to a positive
experience. I know it’s hard to relax when you’re apprehensive, but
this is why I believe we need to lessen the public apprehension of
this test. It is easy to relax by taking some deep breaths before
you have the test. By relaxing your muscles you will be much more
comfortable through the test than if you are tense. An added bonus
is that the films will be of higher quality, as it is easier to
image the back of the breast close to the chest wall if the
pectoralis muscles are relaxed. When it’s done, you may hear
yourself saying, “That wasn’t bad at all!”

Some women are embarrassed to have a mammogram because they don’t
want anyone other than their partner to see and touch their breasts.
The mammogram jokes add to their fear of pain and embarrassment
making it harder for them to manage, and I know of some women who
avoid having a mammogram for this reason. The test is done in
privacy; no one but a female technologist will be present.
Technologists, for the most part, are sensitive people who will do
the test as quickly and professionally as they can. Many women who
have resisted the test for a long time are amazed at how simple and
painless it can be.

Mammograms include compression of the breast with a plastic plate to
produce a high quality image with the least amount of radiation.
Breast compression is meant to be tight, but it should not be
painful and it only lasts for a few seconds. If you think about
looking at a bunch of grapes – it’s hard to see them all from one
spot. If you spread the grapes out, you can see more grapes.
Similarly with the use of compression, more breast tissue is visible
when the breast is spread out. With a flatter, thinner layer of
tissue the amount of radiation required is less than if the breast
is not compressed. The amount of radiation you get is as low as can
be achieved if adequate compression is used, and also if good
quality control is maintained at the mammogram facility.

In the U.S.A. the cost of a mammogram runs between $50 and $150.00.
There is financial help available from insurance companies, state
and local programs, and from some employers. Please do not let the
cost deter you from having a mammogram as the cost of not having a
mammogram can be much higher both financially and emotionally. Check
for information on the internet.

In most places in Canada, women can book their own appointment for a
free screening mammogram; a doctor’s referral is not required. In
places without a screening program, mammography is available with a
doctor’s referral and is covered by health insurance. Approximately
7% of women will be asked to have further testing. Most of the time,
follow up testing involves an additional mammogram with a different
view to separate the breast tissue in a particular area to get a
better image. In my analogy of the bunch of grapes, it’s like having
a few grapes on top of each other and separating them out in a
different way in order to see them better.

There is controversy about the age bracket for women to have a
mammogram. On a mammogram film, normal breast tissue in young women
usually appears to be dense; normal breast tissue in older women
usually turns to fat and appears less dense. Reading mammograms on
young women is like looking through a tree which is full of leaves
in summer. Reading mammograms on older women can be compared to
looking through a tree in winter. You can see why reading mammograms
on young women is more complex than reading films on older women and
this is the main reason why screening mammography is more effective
as women mature.

The fear of being diagnosed with breast cancer will often prevent a
woman from having a mammogram. My personal experience is that it is
much better to be diagnosed earlier rather than when the cancer has
had chance to spread. The amount of fear, pain, embarrassment, and
emotional anguish from having a mammogram does not even come close
to that of being diagnosed with an advanced cancer. A mammogram
takes about 10 minutes; an early cancer can be dealt with in a
reasonable amount of time, while an advanced cancer is much more of
a time commitment. The amount of fear that comes with a cancer
diagnosis is astronomical compared to that of a screening mammogram.

It is often recommended that women have a screening mammogram every
two years, but many people believe it is better to have mammograms
on an annual basis. It is probably best if women can consult their
doctors and make the decision on an individual basis. A number of
factors affect the decision such as age, family history, general
health, and previous breast problems. Between appointments, whether
you choose to have a mammogram every year or every two years, it is
important to be aware of any breast problems. If you notice anything
unusual it is wise to contact your doctor. This applies even if your
mammogram was negative because there are a certain percentage of
cancers that do not show on a mammogram.

The Canadian Breast Cancer Foundation promotes a three-prong
approach to breast health:
• annual clinical breast exam by a doctor or trained health
professional
• screening mammogram
• monthly breast self exam

Breast self-exam can be a controversial issue. Many people do not
recommend monthly self-exams, yet many women have found their own
breast cancers this way. The important thing to remember is if you
choose to do self exam, to do it right:
• learn the proper method from a doctor or trained health
professional
• be disciplined and practice it regularly
• pick the same time of your menstrual cycle or the same date each
month
• get to know your normal breast “architecture”
• make notes of your findings, draw pictures and record dates
• make detailed notes of unusual findings including dates
• check with your doctor if you find anything worrisome

Following these steps will give you confidence and put you in charge
of your breast health. Some health professionals are concerned that
women will be unnecessarily alarmed if they find a problem with
their breasts. I believe that an educated approach to breast care
will reduce the fear that many women live with, and they can consult
their doctors in a more rational manner. Most breast lumps are
benign, but early detection of breast cancer is worth the extra cost
of investigating lumps and other unusual findings.

Mammography is a peculiar test in some ways. However, it is the gold
standard at present and until there is a better method of screening
which is also cost effective it makes good sense to have regular
mammograms. Finding cancer in the early stages before it has a
chance to spread makes the treatment much easier and the cure rate
much higher. Having a mammogram is not meant to be funny, or even
fun; but a few minutes of discomfort rewards us with knowing we are
taking action to help protect our breast health.


About the author:
http://www.cancersupportcoach.com Lynnwas diagnosed with Stage II
breast cancer in 1986 and colon and skin cancer in 1987. She has
been involved in the cancer community since then as a peer
counselor, support group facilitator, fundraiser and retreat
organizer. She works as a mammography technologist in Guelph
Ontario. Lynn is also a life coach for cancer patients to help them
shorten the learning curve and navigate their journey with cancer.