This spring, I had my first screening mammogram. I tweeted about it, and talked to people about it, and while it may not be a “sexy” topic to blog about, I learned it’s something a lot of people have questions about. I also realized that quite a few people I know are scared or intimidated at the idea of having a mammogram. That’s what made me decide I wanted to share my experience.
A couple of quick notes about mammography before we get started:
- Mammography screening recommendations vary, and are sometimes controversial. The American Cancer Society’s guidelines can be found here. I fall into the age 40-45 category, and opted to begin screening. I don’t have a strong family history of breast cancer, but most women diagnosed with breast cancer don’t.
- The dose of radiation used for a screening mammogram of both breasts is roughly the same amount of radiation a person would get from their natural surroundings over about 7 weeks (more info here). I mention this because there are a lot of “health” sites out there claiming that mammograms expose people to the equivalent of 1,000 chest x-rays.
- The pressure from a mammogram will not cause any existing cancer to spread. This is another “fact” I stumbled across frequently in preparing this post. It’s simply not accurate.
- While mammograms are currently the gold standard for early detection of breast cancer, they’re not perfect. There are false positives that result in unnecessary biopsies, and certain types of cancer may be overdiagnosed or overtreated. If you have a mammogram with a suspicious finding, don’t be afraid to ask for a second opinion and/or do some research before proceeding.
- The bottom line from the American Cancer Society: “Results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found early, less likely to need aggressive treatment, and more likely to be cured.”
The First Mammogram
I made my mammogram appointment for the first slot in the morning. Since you’re not allowed to wear any powder or deodorant the day of the test 1, I wanted to get it out of the way early. After checking in, I was taken to a dressing area to trade my shirt and bra for a highly unfashionable hospital gown. I was then directed to a special waiting room. Since the other patients were similarly garbed in flimsy blue gowns, I didn’t feel terribly self-conscious. It was, however, slightly chilly.
After a brief wait, the technician came to get me. She was very friendly, and cheerfully explained the process as we entered the room. She would take two images of each breast, and I’d get a call in a day or two letting me know the results. She also explained that the hospital used 3D mammography (also known as tomosynthesis) to help improve the detection of cancer and also reduce the number of false positive results.
Next I was asked to slide off one arm of my gown to maneuver my boob between the glass plates of the mammography machine. Mammography technicians are trained to get your breast into the best position to get a good picture. They are very comfortable with this task, even if it seemed incredibly awkward from my perspective. It didn’t help that the tech was petite, while I’m quite tall. I kept having ridiculous mental images of the poor woman getting crushed under the weight of my boob as she attempted to heave it into place.
Once in place, the test itself began. The glass plates of the machine come together, squishing my boob into a pancake shape. It was uncomfortable in the beginning, and mildly painful at its worst. If you happen to get a machine where you can see the actual PSI of pressure being applied, I recommend you not look. I swear watching that number go up made it hurt more. Then I was asked to hold my breath for a few seconds while the image was taken. Thankfully, the pressure was released immediately afterward.
After that, it was just a matter of 3 more repetitions. I was then free to reclaim my bra and shirt and go home. I didn’t think much about it, I was about to leave for a business trip and was preoccupied with that. This meant I was somewhat caught off guard when I got the call saying the doctor saw something abnormal.
To the hospital’s credit, they offered to get me back in for a follow up the next morning. The fact that I was a thousand miles away meant I had to wait three days. They also assured me that the abnormality didn’t appear too menacing. It was classified as “needing additional imaging” rather than a suspected or probable malignancy. They told me not to worry.
Me being me, I immediately went online to read the full report. And then I went on a Google spree that was surprisingly reassuring. I learned that having dense breasts means that I’m more likely to have false positive or unclear mammograms. I learned that first screening mammograms require callbacks more often because there are no prior images to compare to. I learned that 80-90% of patients called back for additional imaging don’t need a biopsy.
The process for a diagnostic mammogram is slightly different. This time, they only needed one image of my right breast so it was quicker and easier. There was also a doctor present to review the image immediately and discuss it with me. The abnormality was still visible on the additional view, definitely not just a shadow or artifact. It was, however, small with smooth, clearly defined edges. This usually means a cyst, so I would just need a quick ultrasound to confirm the diagnosis.
Well, that was the plan, anyway. As it turns out, having dense breasts also means it’s hard to locate the exact bit of real estate that corresponded to the spot on my mammogram. It took the technician several tries, then the doctor came in for some additional exploration. In the end, they concluded that the spot was “most likely” a particular complex cyst. The final mammogram report was labelled “probably benign”. But just to be safe, I was to return for a follow up in six months.
Fast forward to October. I report dutifully for my mammogram first thing in the morning. This tech struggles a bit to get the right angle. She asks me, as I stand with my right boob sandwiched between glass plates, if I could please hold my left boob back so it doesn’t interfere with the shot. This strikes me as hilarious. I imagine Left Boob is jealous of the attention that Right Boob is getting, and therefore wants to photobomb the mammogram. To pass the time waiting for results, I start tweeting about it.
And I continue the “conversation” after I’m taken back for another lengthy ultrasound session…
And it wraps up after I’m told that all is well, and I don’t need to return until normal screening time in April. The previously identified abnormality is stable in size and appearance, and definitely matches up with the complex cyst on my ultrasound. So in the spring, both Left Boob and Right Boob just need to get their regular portraits done.
Overall, I would say that my mammogram experience was positive. I feel better having a baseline mammogram to compare with in the event that I need to get a lump checked out at a later date. I am the kind of person who wants to know as much as is reasonable about what my body is up to. Yes, it’s an awkward and uncomfortable exam, but I felt like the peace of mind it provided in the end was worth it.
The one issue I had was the failure to warn patients that callbacks for initial screening mammograms are frequent, and that very few of those callbacks end up requiring invasive follow up. These are, in my opinion, the kind of facts that should be shared with everyone when they schedule their first mammogram to prevent unnecessary anxiety. I did mention this to the staff, as well as on my patient survey, so that perhaps they will update their patient education materials.
I hope my story has been helpful and reassuring to anyone with a mammogram in their near future. If you have questions, please feel free to leave them in the comments or contact me privately if you prefer. I’m not a medical professional, but I’m happy to talk about my personal experience. The single biggest piece of advice I would offer is to ask lots of questions. In particular, be sure to ask when and how you’ll be notified of results, and who you should call if you want to discuss the findings.
If you are a woman over 40 who has health insurance, screening mammography should be covered with no out of pocket cost to you (though 3D mammography may not be). You can also self-refer for a screening mammogram, you don’t need to see your doctor to have it ordered.
If you don’t have health insurance, you can check here for information on low cost or free screening programs. Local hospitals or clinics may also be able to assist you in locating services.
- These substances can be picked up on mammography images, and obscure details of the scan. ↩