Slipping Confidence In Screening
At age fifty-six, as I stood in the small room at the breast center, my left breast sandwiched between two metal plates for my yearly mammogram, I didn’t realize it would be my last screening. In fact, I can’t remember just when my confidence in screening mammograms started to slip. Maybe it was after reading an early edition of Dr. Susan Love’s Breast Book, which I’d bought with the intention of passing it on to my sister the year she had her mastectomy.
I was impressed by how plainly and intelligently Love, a breast surgeon, presented the research findings about mammography. Her discussion of both the pros and cons of routine screening seemed more reasoned than what I was reading in the clinical literature and hearing at conferences. If my physician or nurse practitioner colleagues had reservations about the screening protocols we advocated, they weren’t voicing them. Mammograms were, after all, standard practice.
I began to plow through research studies online and in the medical library. I studied the wordings of my patients’ and my own mammogram results. They were almost never reported as normal, but as “benign findings” or “no evidence of malignancy at this time.” Keep coming back, they seemed to predict, and we’ll find it. I observed how the need for a repeated image, a call back, or the mere mention of words like lump, mass, referral—even watch—culled a woman from the world of the carefree well forever.
In my practice and personal life, I saw how women embraced the well-intentioned but relentless messages from medical, workplace, and women’s groups to “take the test, not the chance.” Mammograms save lives, we were reminded. You owe it to yourself and your family. Be responsible.
Campaigns were mounted against insurers that didn’t cover yearly mammograms. Free testing for poor or uninsured women became a cause to be championed. It did no good to remind women that heart disease and lung cancer take more women’s lives than breast cancer. They knew that breast cancer strikes younger and harder. And there’s no practical way to prevent it.
There were feature stories about celebrity survivors as well as “everyday” women whose breast cancer, thanks to a routine mammogram, was found early and treated fast. Breast cancer gave new meaning to the now-annual race, the color pink, the month of October (which has become Breast Cancer Awareness Month). Industries from T-shirt manufacturers to radiology departments geared up to support this new movement.
Then research reports began to filter into the media from unfamiliar, foreign-sounding organizations like the Nordic Cochrane Centre. (The Nordic Cochrane Centre describes itself as “an independent research and information centre that is part of The Cochrane Collaboration, an international network of individuals and institutions committed to preparing, maintaining, and disseminating systematic reviews of the effects of health care”; its Web site is http://www.cochrane.dk/.) The reports verified the benefit of mammography screening—for a few women, at a significant cost in unnecessary follow-up and treatment for hundreds of others. But minds that were made up didn’t open to take in this new information. The whole engine of breast cancer awareness was—and still is—simply too big, too powerful, and too well funded to gear down.
I continue to shock friends when the subject of their latest date with the mammographer comes up, and I admit that I’m no longer a member of the club. I can’t bring myself to smile at the cartoons, laugh at the jokes, forward the e-mails with the funny stories, or wear the pink ribbon. Nor do I, unless asked, elaborate on the compelling data that have informed my own decision.
I discovered early on that facts alone would sway no one. So I simply listen respectfully to other women, many of them close friends. They tell me that, thanks to early detection and surgery—often followed by grueling courses of chemo and radiation—they or their best friend, sister, or mother are here today as survivors with many healthy years ahead of them.
"Why I Don't Get Mammograms"
A nurse practitioner with a family history of breast cancer shares why she stopped getting mammograms.
Slipping Confidence In Screening