Breast cancer. Those two words send a small chill up my spine. As a woman, it's at the top of the list of potential ways I may become ill, or even die. Breast cancer has already struck two women in my family: my aunt and my grandmother, both twice. My grandmother's frail, 87-year old chest, which once fed each one of her seven children, is now flattened from a double mastectomy. It is a stark reminder that something that nourishes life can also take it away. She is a survivor. My aunt was fortunate enough to escape the grip of breast cancer with radiation. She is a survivor. But I wonder, what did they survive? To survive implies an outside attack, an invader or enemy wishing to do you harm. But that's not what this is. Breast cancer is an attack from within, on itself, a "friendly fire" of sorts. Unfortunately, that's only one of the battles women need to fight to survive this war. The other battle is a lifelong, persistent one that surrounds us all each and every day. It's the battle of fear and confusion.
There isn't a month that goes by where I don't read an article with "new evidence" of yet another environmental agent that causes breast cancer. "How your bra is killing you," or "How dangerous is your deodorant?" are the typical, fear-inducing headlines. A quick Google search offers me a plethora of agents that could give me breast cancer and there's no way to know which, if any of them will awaken the sleeping bear inside me until it happens. Sure, I can send off my DNA to a lab, where for a couple thousand dollars, they will tell me if I'm carrying a mutated copy of the BRCA1 or BRCA2 gene. According to the National Cancer Institute, carrying this genetic marker may increase my likelihood of developing breast cancer by 5-25 percent, depending on my hereditary predisposition. I figure if I have the mutation, wear underwire bras, use deodorant, drink from plastic cups, eat dairy products, have a vinyl shower curtain, use mothballs or air fresheners, I'm a goner for sure. But even with the DNA results, what would I do differently? How could I even begin to sort through the noise?
“The fear is often worse than the diagnosis.”
And if that's not confusing enough, the industry screening recommendations are constantly changing and conflicting. Should I start getting mammograms at age 45 or 50? Once per year, every two years? Is the traditional 2D mammogram good enough or should I seek out 3D tomosynthesis? Do mammograms work if I have dense breasts? What about ultrasounds and MRI? Wait, x-ray imaging emits radiation. Radiation causes cancer. How can a cancer-causing procedure help me beat cancer? If all of this weren't bad enough, the worst is a misdiagnosis. One study found that after 10 years of annual screenings, more than half of women will receive at least one false-positive recall, and 7-9 percent will receive a false-positive biopsy recommendation. And the psychological effects are more harmful than previously thought. In the first six months after diagnosis, researchers found that while women with positive findings expressed more change to inner calm and existential values, there was no statistical difference between women with breast cancer and women with false-positive findings. The fear is often worse than the diagnosis. I'm unable to detect cancer in my body, which is why I place such an incredible amount of trust in modern healthcare and rely on my doctors to accurately detect cancer. But what if they're wrong?
It's. Too. Much.
If you aren't sure, these are the current breast cancer screening guidelines:
- United States Preventive Services Task Force (USPSTF) recommends that women 50-74 years of age receive biennial screening mammograms instead of annual screenings starting at 40.
- The American College of Radiology (ACR) and Society of Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40.
- The American Cancer Society recommends that all women begin having yearly mammograms at age 45, and can change to having mammograms every other year beginning at age 55.
“None of us are alone in this fight
As a solutions manager for both a radiology PACS and a breast MR CAD product, I work with radiologists specializing in mammography every day. We talk about workflow efficiencies, consolidating workstations to a single reading platform, optimal hanging protocols, and adding breast imaging modalities. While each hospital and imaging center has different imaging offerings, techniques, and workflows, they all have one thing in common: giving women a fighting chance by detecting breast cancer in their patients as early as possible. Every radiologist has a mother, sister, wife, daughter, or friend. It affects us all, and the level of care and concern I've seen from mammographers surpasses any other specialty. None of us are alone in this fight to survive.
So what am I going to do? In short, make good decisions, trust myself, and live my best life. What that means exactly will be different for me than it will be for you. For me, it entails keeping my stress down, watching my weight, feeding my body nutrition and not poison, getting enough rest, and listening to my body. I love being a woman and one of our greatest strengths is intuition. If I feel that something is wrong, it probably is. If I want a second opinion, I'm going to get one. Until then, what I do have for sure is today. Today, I can feel the sunshine on my face. Today, I can hug my mother. Today, I can make a baby smile. Today, I can laugh with friends. Today, I can play fetch with my dog. Today I will thank my body for keeping me healthy through all the ups and downs of this life so that I can live to fight another day.