You don’t find many volunteers in the newsroom to write about mammograms. The women wince and the men turn progressively pink at the thought. After the women wince, they come up with excuses for not having one: “Oh, I don’t need one until I’m at least 50,” or “No one in my family has had breast cancer.”
More often than not, we just don’t talk about it at all. Maybe because it’s embarrassing, or maybe because we think healthcare is something that happens only after a problem becomes obvious. Well, here’s something else to think about: the mammogram is the most effective screening tool for diagnosing breast cancer, a disease you really need to find long before symptoms make it obvious. And I can tell you firsthand, a mammogram is not nearly as bad as you might imagine.
Breast cancer is the most prevalent type of cancer in Egypt and the second most prevalent type of cancer in the world after lung cancer, according to 2008 statistics from the International Agency for Research on Cancer (IARC), part of the World Health Organization. Breast cancer accounts for about 38 percent of all cancer cases of women in Egypt. It is also the single most-diagnosed cancer in the nation overall, accounting for nearly 20 percent of all cancer cases among men and women.
But to hear women’s reactions to the word “mammogram,” you’d think the test was worse than the disease. The mildest comment I heard about mammograms came from a woman in her 50s who told me (after wincing), “I had one once, because I knew it was something I had to do.”
It is something I also have had to do and will willingly (if not eagerly) do again, because the benefits far outweigh any discomfort from the procedure.
The much-dreaded mammogram is simply a low-dose x-ray scan — on par with a dental x-ray — on a machine specifically designed for taking pictures of the breast.
I will not lie: It is not comfortable to have a soft prominent part of your body squashed between two hard, flat, square plates. It hurts... for all of two seconds. Literally. I timed it. “A thousand one... a thousand two...” done.
The technician hit the “on” button, the plates compressed, the machine made a business-like hum, then an extended beep, and the pressure released. It takes longer to remove your shirt and bra than it does to do a single scan.
A screening mammogram consists of four scans: one horizontal compression and one vertical compression of each breast. If the x-rays are clear, you can get dressed, your screening is over.
According to the American Cancer Society (ACS), about 10 percent of women who have a mammogram will require more tests. I was one of that 10 percent. The doctors at the Women and Fetal Imaging Center in Manial read the mammogram while I waited, and noticed a lump that my gynecologist and I had both missed in a palpitation exam. So the staff immediately ushered me into another room for an ultrasound.
Even if the docs do find a lump, chances are very good it’s benign. The human breast can develop fibrous masses, fluid-filled cysts or other types of non-cancerous growths. The ACS estimates that only 8-10 percent of women who require follow-up tests will need a biopsy, and about 80 percent of those biopsies will turn out not to be cancer. After consulting with the radiologist, my gynecologist and a plastic surgeon, we determined I did not need a biopsy.
Uncomfortable Conversation
A mammogram is a simple, albeit a slightly uncomfortable process. So why don’t we talk about it? To talk about mammograms is to think about that big C: Cancer. We don’t want to tempt fate, don’t want to contemplate or publicly admit to serious illness in the family, much less admit to a disease in such a personal part of the body like the breast. For whatever reason, cancer is a little like Harry Potter’s Lord Voldemort — the disease which cannot be named.
But take a minute, just one minute, to list how many people you personally know whose lives have been touched by cancer of some sort, either because they’ve had it themselves or one of their family members have had it. Just two degrees of separation.
Off the top of my head, I came up with at least 16 people, nine of whom had or still have breast cancer. That’s just among my family and close friends. If I started actually polling people and including high-profile cancer survivors like Tour de France champion Lance Armstrong and American rock star Melissa Etheridge, those numbers would mushroom. For a disease that cannot be named, there are an awful lot of us out there who know what it’s called.
If there’s any real controversy about mammograms, it’s when to start having them. The 20- and 30-somethings can breathe a sigh of relief: mammograms are not a standard screening test for women under the age of 40, especially if they don’t have a family history of breast cancer.
Younger women typically have denser breasts that make the x-ray imaging less effective at illuminating masses. As women get older, breasts become less dense, meaning abnormal masses show up better in the scan.
In 2009, a widely publicized study by the US Preventive Services Task Force recommended that biennial screening mammography for women start at age 50, not 40 as common medical advice suggested. The study looked at screenings in terms of a national healthcare policy, comparing benefits such as extended life years to harms such as false positives leading to unnecessary tests such as biopsies. US researchers concluded that regular screenings every two years starting at age 40 reduced breast cancer mortality by only about three percent, but generated more incidences of false-positive mammograms, causing financial, physical and emotional stress.
A Swedish study presented at the 2010 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium refuted the US task force findings. Examining 600,000 medical records from Sweden’s national health system, researchers compared breast cancer diagnoses and outcomes for women who started biennial mammograms at age 40 to those who started screenings at age 50. The Swedes found that women who started screenings earlier were 29 percent less likely to die from breast cancer.
The issue was not about a mammogram’s effectiveness at reducing an individual’s chance of dying from breast cancer, but the overall net benefit of starting regular screenings earlier. Ultimately, when to start regular screenings is a conversation for your gynecologist — women with a family history and other risk factors may benefit from mammograms even earlier than age 40. Because the one thing the medical community agrees on is that the earlier you catch breast cancer, the better your chances of surviving it.
How much better? According to the ACS, if breast cancer is caught at stage I, where the tumor is less than two centimeters across and has not spread to more than three surrounding lymph nodes, then the five-year survival rate is 98 percent. By the time a tumor reaches five centimeters and spreads to four or more lymph nodes (stage IIIA), the five-year survival rate drops to 56 percent. Once the cancer spreads beyond the breasts into bones or other organs (stage IV), the rate drops to 16 percent.
A mammogram will not prevent breast cancer, nor does it cure or even treat breast cancer. But it can be an early warning, which greatly increases your chance of surviving it. If a cancerous lump isn’t found until you can feel it with your fingers, it may be too late.
By IARC estimates, nearly 1.4 million women worldwide are diagnosed with breast cancer each year. And each year, 458,000 women die from the disease. In Egypt, about 12,600 new cases are diagnosed annually, with more than 6,500 women dying each year from breast cancer. Egypt’s mortality rate is 20.1, notably higher than the global mortality rate of 13.2 for the disease. Breast cancer is the leading cause of cancer deaths in this country.
If there’s one thing my informal conversations around the office taught me, it’s how little people actually know about mammograms and breast cancer. And that ignorance is clearly killing us.
October is Breast Cancer Awareness Month. It’s as good a time as any to call your mothers, your sisters, your aunts, your wives and start talking. And for those of us eligible for screening, call your doctors to schedule a mammogram. There’s no good excuse not to. et
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