Although our health system pays a lot of lip service to breast cancer prevention, at times, providers fail to put their money where their mouthes are.
Case on point: why in the world is it so difficult to get an order for a mammogram more than once every twelve months??? What is the concern…? It’s not like women will dive into over-screening just for kicks —it’s no fun to get your breasts squashed between two plates while a soothing-voice technician tells you“breathe… now, don’t breath…. now, breathe…”
Apparently, having a screening mammogram more than once a year is not the “standard of care”.
Seriously? Isn’t the risk of sitting on undetected rapidly-multiplying cancer cells enough reason to revisit the standard?
Let me share my story, and then you can decide whether or not my frustration is warrantied—I don’t want you to think I am venting just because.
Back in late May 2020, I had my regular annual mammogram. The images came back nice and clean —no surprises and nothing to talk about. Fast-forward seven short months —yes, you read correctly, S-E-V-E-N—, I was charmed with a 1.5cm triple positive breast cancer tumor. And, although 1.5cm is still considered “early stage”, an even earlier finding (say, with imaging at the three, four or even six-month mark) could have kept me at stage zero, detecting a smaller-size and more-contained tumor, and saving me from chemotherapy and radiation. Wouldn’t that have been nice? Sigh…
My most recent mammogram (that is, after my Big C diagnosis) was on May 17, 2021 —Happy Birthday to Me! There was a cyst, which turned out to be only water, but, nonetheless, THERE WAS A CYST! This means that, between my cancer-diagnosis imaging in January and May (four months later!), the images did not come back nice and clean.
Now, without going into too much information, let me explain something: once you undergo a lumpectomy and they reshuffle your breast fat and tissue, things don’t feel quite the same, and you find yourself constantly searching and discovering random “maybe-lumps”. Hence, being currently at the four-month mark from my last mammogram, I asked one of my providers for a new order to make sure everything was nice and clean and I had nothing to worry about.
To my surprise, I was told it wasn’t necessary and I was on a “mammo schedule” every twelve months…
Seriously? —I asked in disbelief. Have we not learned anything from my 2020 experience? If I went from clean imaging to 1.5cm cancer in barely over half a year, and had a random water cyst four moths later, what makes anyone think it is OK for me to sit tight and wait twelve months?
Let’s make a fun-fact digression here: Did you know men on testosterone replacement therapy (TRT) usually get their hormone levels checked and regulated every three to four months?
I cannot help but wonder… Why is the frequency of a woman’s potentially life-saving screening mammogram deemed less necessary than a man’s non-life-saving (sorry, guys...) erection-improving and muscle-defining TRT shot?
Back to the conversation with my provider, there was a long explanation, and the words “standard of care,” “insurance approval,” and “highly unusual recurrence” all blended in one with the another. I could feel the blood rushing through my veins and cortisol climbing over my head in a mix of anger, despair and F-E-A-R… And, of course, as night came, I went back to playing the “Is-It-Cancer?” game, self-examining home alone and driving myself crazy with all my “findings”, which, in all honesty, are most likely high density tissue and nothing to worry about.
I will save you the play-by-play, but, after banging at a few doors and several conversations with wanna-be empathic individuals, I went to my common sense primary care physician —Dr. V.— and she produced the orders I desperately wanted, without blinking an eye.
I am now scheduled to have a mammogram and ultrasound combo this coming Monday, and I may have to pay out of pocket, but it’s a drop in the bucket when compared to the risk of a cancer ticking bomb.
According to cancer.org stats: this year, over 280,000 women in the United States will be diagnosed with invasive breast cancer (that is, breast cancer which has passed stage zero and spilled out of the milk duct, often requiring radiation and chemotherapy), while only about 49,000 women will be diagnosed with non-invasive (in situ) breast cancer (that is, breast cancer which remained entirely contained in the milk duct and usually, after surgery, requires no systemic treatment and allows you to move on with life).
So, although more frequent mammograms cannot eliminate the risk of breast cancer developing, they can help catch it earlier than what we currently are. They can help shift the stats from invasive to in-situ or, put differently, they can help keep more women at stage zero, rather than stage one and beyond.
Thousands of women like myself moved from nothing to invasive stage in well under a year, and the data is readily available (providers and insurers need to be willing to open their eyes). In light of that, my question to the system is simple: why do you keep pretending a mammogram once a year is screening and preventive enough?
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