So what if you don't have a 'family history'?

I have finally reached that age. If I was pregnant it would be referred to as "Advanced Maternal Age" but since I am not, it just means that my reproductive organs are no longer as young and healthy as they used to be. OB visits are getting depressing because my doctor is always talking about things that I usually associate with older women, but now he is associating them with me. As in "At this point, then, you might want to think about more permanent birth control". (On one hand I am perfectly willing to leave it up to Greg, but on the other hand that seems so final.) As in: "it is time for you to go for a mammogram".

This is an important event in every woman's life, and I know many women who don't get their recommended mammograms because they are afraid, or blase about it. So let me share my experience with you, and help educate you a little bit as to why this is so important.

First of all, a disclaimer: I am not an MD. However, I do research into the molecular biology of breast cancer, and I hang around MDs who are treating women with breast cancer, so I do have more then average knowledge about this topic. Second of all: In reality I am still relatively young, and your risk of developing breast cancer increases with age. For a healthy 37 year old, the real reason for getting a mammogram is to have a healthy baseline, a 'normal' against which to compare all future mammograms. I made my appointment a few weeks ago and today was the big day. Here is how it went, and some interesting facts about the process.

1. Preparing for the visit.
I prepared for my visit to the radiologist by showering, dressing, and omitting all perfume and deodorant. That, in fact, was the most unpleasant thing about the experience: the fact that I couldn't wear deodorant. I was worried about sweaty pits and stinky b.o., and being nervous about the procedure meant that these were very real possibilities. Why are these substances banned? It turns out that many perfumes and deodorants have a small amount of metal or calcium in them, (ie, the aluminum that is in many antiperspirants). The x-ray will pick up those metals or minerals and may lead to a false-positive reading of the mammogram. It might seem trivial but it is important, so off I went with my deodorant in my backpack, and my armpits shower fresh and clean.

2. The preliminaries.
I arrived at the Radiology office, checked in, was given an armband to wear, and sat down to wait. Within five minutes I was called in. We walked into a dressing area and I was given a hospital gown and told to take my shirt and bra off. Once I was dressed in the voluminous gown, I followed the radiologist to the Mammography room. There she started by asking me a few questions: what was my age, was I having any problems, when was my last period, and did I have a family history of breast cancer. I am going to dwell on this last question a little bit because it is a significant one.

3. Breast cancer risks and family history.
I have heard women say that they don't need a mammogram because they don't have a family history of breast cancer, and this kind of misunderstanding angers and worries me. Yes, if you have a family history of breast cancer, or if you have the breast cancer gene, you have a higher risk of developing breast cancer. What does that mean, to have the breast cancer gene? That phrase can be a bit misleading; the so-called breast cancer gene refers to the gene for BRCA1 or BRCA2 (for breast cancer susceptibility 1 and 2). The truth is that everyone has this gene. These genes make proteins that are expressed by every person and, normally, serve an important role in your cell. When someone tells you that you 'have the gene' what that really means is that you have a mutation in the BRCA1/2 gene that makes the protein function abnormally, and it is that abnormal function that contributes to the development of breast cancer. If you 'have' the gene, you have up to an 80% chance of developing breast cancer, and you will hopefully go for more frequent screenings, including mammograms. But here is the thing: most of us do not have the breast cancer gene. And yet we are still at risk. Here are some statistics that might help drive the message home:

1. percentage of women who will develop breast cancer in their lifetime: 13%, or 1 in 8
   
2. percentage of women diagnosed with breast cancer who do NOT have a family history or a hereditary BRCA mutation: 90-95%
   

Can I repeat that last point? Up to 95% of the women who get breast cancer do not have a family history or the breast cancer gene! Yes, there are certain risk factors but the reality is that for most of us, you just cannot predict your likelihood of getting breast cancer. The best thing you can do is get regular check ups, perform breast self exams, and go for your routine screening- the mammogram. Breast cancer is harder to treat if it is more advanced; that means that the sooner you find out you have cancer, the better your prognosis. And this is why everyone should go for their recommended mammograms:

• baseline mammogram at 35-40 years
• 40 years and older, mammograms every 1-2 years
• And of course: any time you are concerned
• More frequently if you are at higher risk.
  

4. The Mammogram.
The radiologist told me we would take four images, two of each breast. She made me slip the robe off my right shoulder then she lowered the machine until I could rest my breast on the lower plate without having to stand on my tiptoes. I had to turn my head to the right to avoid a glass plate, which I think functions mainly to keep your body upright. She then lowered the upper plate until my breast was firmly squished between the two plates; she told me to tell her when it was tight, and it was uncomfortable but not painful. She walked over to her computer, which was behind a small screen; mammography is a very low dose x-ray and so there is a small risk from the x-ray exposure; but that risk is far outweighed by the benefits of the procedure. In other words, more women are helped by mammograms than are hurt by it. (In fact, I don't think that any women are actually hurt by it.) She pushed her button and three seconds later as I tried to "Relax!" it was done. The images were digital and I could see them on the computer screen. She looked it over to make sure it was clear, and once she was satisfied, she released me from the vise and then we repeated the procedure for my left breast. Next, we had to get a different angle; so she tilted the platform to 45 degrees, I raised my right arm, and again she trapped my breast in the vise. This angle helps get all the breast tissue that extends towards the armpit. This angle was slightly more uncomfortable, but again it was not painful, and again it only took a few seconds. She actually wasn't pleased with the first image so we had to adjust slightly and she took it again, then we moved on to my left breast, and then she said "OK, thanks." And that was it.

I dressed, walked out, and got to my car, and it had only been 20 minutes. My coffee was still warm, even. No one was around so I applied my deodorant, and the ordeal was behind me. I still had to pay for the full hour of parking, but that is a small price to pay for the peace of mind that comes with knowing that I am taking responsibility for my own health.

5. The results.
I haven't gotten the results yet, and I hope and pray they are OK. They told me that they will convey the results to my OB, and to expect his call within a week or so. However, I do know that most of the time they see nothing, and that if they do see something suspicious it usually ends up being nothing, or something benign. If they do find something they will call you in for further screening, ultrasound, or even a biopsy. Don't let fear of the procedure or the results keep you away from one of the most important things that you can do to take care of ourselves. Go get your mammogram!

One final word:
It does make a difference! At lab meeting one day, one of the MDs who also runs a research lab told us the interesting fact that it is getting harder to obtain tumor specimens to use for research because since more women are getting mammograms, they are finding their tumors earlier when they are much smaller. They are getting cured, and that is good for them, but bad for the scientists who use that sample for research.

References: these were found through simple Google or PubMed searches
Mammography:
National Cancer Institute
Medline (National Institutes of Health)
BRCA1/2:
National Cancer Institute Fact Sheet
Memorial Sloan Kettering Cancer Center
Breast cancer screening:
American Cancer Society summary of guidelines; Pubmed link (you can get the free full text article through Pubmed)
For a laugh
And most importantly: talking to both my doctor and the radiologist. They answered all my question with patience and sincerity. Then I went home and did some research myself and found out they were both accurate and truthful.

Pass it on: click on the title of this post to get a link and send it to any woman you know who might need this information!