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April is the New October

IMG_1350The last time I had a mammogram, it was in October of 2015. I was ambivalent about whether I would go two years or one year, as there is a debate going on about that. October is the traditional month for breast cancer awareness, and when I happened to have my last screening, but I waited until things thawed out and went for my mammo on a pretty spring day.

I didn’t want to go. I had to go all the way into New York City, which takes a long time, and I did not feel like it that day. There were other things I really wanted to do. But I went, and I plan to do this every April now.  In part, the wonderful thing about April is the pretty tulips, and flower gardens, all over the city!

The fight between one and two years for mammo frequency may not be very significant.  We all wait too long for tests sometimes. We push off appointments. Life is busy. There are false positives and we try to avoid those too. And I’ve known women who had perfect mammograms but discovered breast cancer on their own. There are always those stories. And the minimizing of the radiation is a logical reason to wait. But you know what really turned it around for me? My doctor suggested that the motivation behind the new two year recommendation is economic. As a sociology major who studied economic theory, I think he makes a good point.

So who saves money if I go two years? The insurance companies, not me. Mammograms on most insurance plans are free as long as it is the current preventative care recommendation. Think about it. A trend toward reduced care likely hurts the consumer. The new concept threatens to take something away, not add anything of value.

The idea resonated, so despite the radiation issues, I am just going to do it, until research changes that.  There are good points on either side of the issue, but I have to make a choice, even if it is just to stop thinking about it for now!

Later in the day –not anywhere near the hospital–I met a woman and mentioned that I went to the city for a mammogram. She said “good for you” and went on to tell me that she is a breast cancer survivor. That synchronicity was another thumbs up to do this again, same time next year!

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Is there a trend away from aggressive treatment?

13948I haven’t written in awhile on DCIS because I have not seen anything new lately, but recently, a well-publicized article caught my attention. While the article focused on the mammogram debate, it also noted that there is new thinking on the DCIS front.

I looked into this. There is nothing very new, but there is a seeming trend towards reconsidering extreme options for treating DCIS. I read another article in the Baltimore Sun titled Doctors Seek to Scale Back Treatment for Common Breast Cancer Diagnosis, which emphasizes the idea that DCIS rarely causes harm, but it can turn into breast cancer. The author notes that DCIS is sometimes referred to as stage-zero cancer, or pre-cancer, and again, this concept is nothing new. However, the subject of risk came up. Do we want to treat a pre-cancer as radically as a full-blown cancer? Studies are cited, and the article includes quotes from physicians, including Dr. Esserman. It is a good article that visits the nuances of decision-making, and why it is still so difficult to know what to do. But does it really point to a new way of thinking? The short answer is, not really. The topic is still very controversial, but with headlines like this, there is a suggestion that perhaps the community is looking into the difficulty in making decisions for those diagnosed with DCIS. It is a recognition that women aren’t just doing what they’re told. They are thinking about their options.

The article looks at choices, such as the one that Angelina Jolie made. At the time her situation became public, I co-authored a blog post titled Angelina Jolie’s Decision at Everything Noetic on why it was courageous for her to have made that choice. Personally, I would vie for watching and waiting as opposed to taking radical action. Of course, it is easy for me to say. When faced with a 5% chance of breast cancer, I decided to do a surgical, incisional biopsy, a procedure that my doctor assured would have removed the DCIS with clean margins had it turned out to be positive. Truthfully, I don’t know what I would do had things gone a different way. Plus, I didn’t watchfully wait, nor did I do the less invasive stereotactic biopsy. It is hard to know what you would really do in any given situation that has not yet occurred.

When it comes to treating DCIS or a suspicious mammogram, I do not think there are right and wrong answers. I do however hope that future research will support a trend away from aggressive treatment.

It’s that time of year…

eggsAgain, pink ribbons appear on my eggs, but now I am used to that in October. Just as pumpkins and disembodied heads decorate our front porches, pink ribbons make an appearance this time of year.

I can’t believe it is over a year since I posted. I had my mammogram last week, and going to an excellent facility really makes the process easier. When I arrived, I requested that my x-rays be read while I wait, since I have to travel to get to this better than average women’s center. They were more than happy to oblige, and I only had to wait five minutes while one of the three radiologists read them. So I left without the fear of a callback. Once you’ve had callback, you know that getting a routine screening leaves you a bit uneasy until you get the letter saying that everything is okay.

Also, I was asked if I wanted a 3D mammo and while I have not researched this extensively, I did read that it emits more radiation. The radiation in the standard mammogram troubles me, so I told the technician I will stick with the regular one.

I have not done any additional research on the value of mammography other than to discuss it with my doctor.  Although I have concerns about this path, I have not yet been  able to find a better solution to the problem of this screening. I just don’t want to take a chance and skip it when all the leading physicians and organizations are in agreement on this one thing. Does it cause unnecessary biopsies and does it fail to catch fast growing cancers? Yes, on both counts. But again, there is no perfect screening and right now, this is the only thing acceptable to my doctors so I will stick with it, but I am certainly open to other ideas.

One thing that might help is to go two years instead of one, according to new research. This way, there will be a reduced amount of radiation, but the routine stays in tact. I did wait 15 months–not 12–to get mine. I generally do push the limits for many screens, knowing that guidelines are probably more stringent than they need to be. That annual breast cancer screening is still the norm is suggested by the fact that the technician mentioned my tardiness and asked if I had trouble getting an appointment.  I just told her no. Anyway, I am glad that’s over and I will probably do it again in another 12 or 15 or 24 months.

Reluctantly Getting My Mammograms

I just had my mammogram a few weeks ago and the results were fine. Whew! When you get the films taken, you just never know what to expect, so it is a good feeling not to have a callback!

I was recently going through some old papers and came across an article by Shannon Brownlee who wrote a”What’s wrong with Cancer Tests?” The article was printed in Reader’s Digest in April of 2009.  In the article, there is a nifty little side bar that includes the suggestion that screening for cancer might be right if there is a family history, if you have a risky mutation, or if you already had cancer. Yet, she suggests thinking twice if you are under 50 or over 70, if you’re frail, and if you are afraid of being harmed by a treatment you don’t need. Most people would fit into the “think twice” category, and people who already know they are at risk would probably be best off screening. I also found a short YouTube video of Shannon Brownlee speaking about Cancer testing. Her approach is well-reasoned. I think we all have to think hard about whether we want to be tested, the risks of being tested, and the risks of not being tested.

This blog that focuses on DCIS is about the choices we have to make when presented with questionable mammogram results, and it also delves into making general screening decisions. During my recent screening for example, the technician took two extra films because they were not perfect and she prefers to do extras rather than take a chance of a callback because the doctor is not sure. So right there, there is more radiation exposure just to avoid the potential of a new set of films.

I guess my strategy now is a bit passive-agressive: get the mammogram but delay it as much as my comfort allows.

And I think for many of us–myself included–we only have so much time in the day to explore these things. When it comes to critical decisions, we do the research, but when it comes to screening, we tend to rely on the judgment of our health care professionals and kind of what everyone else is doing. My experience with just following the rules did lead me to a point where I had to do the research, and that was the inspiration for this blog.

I  will continue to update my story and add news about DCIS and breast cancer where I find it. In the mean time, don’t hesitate to pose a question. I would be happy to research and write about any relevant tangents. I hope that in some way I have helped people looking for information as they make incredibly difficult choices when exploring their options regarding breast health.