If you are a 40-year-old woman who has never had any symptoms of breast cancer, your doctor or your health insurance company probably will nudge you to get a “baseline mammogram” or “screening mammogram” done. This could detect any tumor that might be lurking, but most likely you won’t have a tumor and this procedure will create an image of your healthy breasts that can be kept on file to compare to later scans. It seems that a big part of cancer detection is looking for changes in a patient’s tissues rather than waiting for something to get so weird-looking that it’s obviously abnormal.
I had a baseline mammogram earlier this month. The nurse who did it cautioned me that I was likely to be among the approximately 10% of women who are asked to come back for additional scanning after the doctor looks at the first images, because I have “dense tissue” (this is a polite way of saying “small breasts”) which is more difficult to scan thoroughly because it doesn’t mash so nicely in the scanner. Indeed, I got a letter telling me to call to schedule a re-mash. It hasn’t been done yet, but I’m not worried (much) because I am one of those rare Earthlings with no family history of breast cancer. The reason it hasn’t been done yet is an important fact about the scheduling of mammograms, which nobody bothered to tell me until I was in the hospital gown, having taken off work and skipped wearing deodorant on a hot humid day, all ready to get scanned–and they had to cancel it.
Here is what everyone involved in arranging for patients to get screening mammograms ought to be trained to say:
“We recommend that you schedule the procedure in the first two weeks of your menstrual cycle, if possible, for best results.”
Is that so hard?! I can understand that many hospitals have staff who only do scheduling and have no medical training, but that one sentence could pop up on their screens when they click to schedule a mammogram. If the patient is past menopause, she could just shrug it off. If the patient is unable to get a date that’s at the right time for her–perhaps because there’s a long wait time and her cycle is too irregular to predict–that phrasing indicates that the timing isn’t super-crucial. (It is more crucial if the patient is actively trying to get pregnant. If you’re old enough for a mammogram but still hoping to have a baby, make sure all your medical professionals know about this!) I contacted the hospital suggesting that they train schedulers to say this, but after more than a week they haven’t gotten back to me.
Let me reiterate that I’m talking about screening mammograms–when your breasts are being scanned to check that they’re healthy–not “diagnostic mammograms” that are investigating whether a lump is cancer or something harmless. If you have symptoms that might indicate cancer, get your mammogram right away.
A little research taught me that there are three reasons to have a mammogram early in your cycle rather than after ovulation:
- It’s more accurate. Research shows that cancer is more easily seen when breast tissue is less dense and that it becomes more dense after ovulation. I suspected this because my breasts get very uncomfortable in the premenstrual phase, and they certainly feel denser–so when I realized that I had scheduled my followup screening two days before I expected my period, I called back to ask whether this would be a problem. The scheduler told me it wouldn’t. It’s not her fault nobody told her, but our health care systems could be saving money, reducing radiation exposure, and even saving a few lives by scheduling mammograms at the time when they are most accurate. Reducing false negative results would get more cancers diagnosed early when the odds of successful treatment are higher. Reducing false positive results would reduce the number of women who have to come back for more scanning.
- You can be certain you’re not pregnant. This is the official reason the hospital turned me away: Because I am sexually active and not sterilized, because I understand that all contraceptive methods can fail, and because I was 11 days past ovulation, when the nurse asked me, “Is there any chance you could be pregnant?” I said, “It’s unlikely.” She was upset. Although I explained exactly what I meant, she told me the hospital would not take the risk of exposing an embryo to any X-rays that might get around the lead apron. Although I later learned that mammogram during pregnancy is believed to be safe, I understand and appreciate the hospital’s concern. I just wish they were more careful how they check for the possibility of pregnancy. A typical woman who’s been, say, using condoms most of the time and not planning to get pregnant would say, “No,” when asked, “Is there any chance you could be pregnant?”–and a few days later, she might realize that she actually is pregnant.
- It’s more comfortable. Getting your breasts squashed in a machine is never going to be fun, but it’s worse if you already have premenstrual “tenderness”–when anything touching your breasts or any movement of your arms hurts. This is a big problem for me, so that’s really the reason I hoped the scheduling lady would switch me to a different date. (In retrospect, I should have just said I “can’t make it” that day.)
I don’t think my local hospital is unusual in failing to consider the timing of my mammogram with my cycle. Although the information above was easy to find when I looked for it, I had never heard any of it mentioned by medical staff until I talked with the nurses at the desk after being told to reschedule my scan. I’ve never seen it widely publicized (like in women’s magazines) or heard about anyone I know scheduling a mammogram for a specific phase of her cycle. I’d bet that most hospitals don’t think to ask patients to consider their cycles, and that’s why I’m writing this.
I’m getting that followup scan next week, when the timing will work for me! Visit Works-for-Me Wednesday to see what’s working for other people.
P.S. Check out my guest post at Live Renewed today, How to Get Started Line-Drying Your Laundry!
UPDATE: I don’t have cancer! Whew.