Respectful Insolence

I’ve been a bit remiss in my duty toward a fellow ScienceBlogger.

No doubt a few were wondering (or maybe not), why I, as the resident breast cancer expert here, didn’t point out that my fellow ScienceBlogger Janet live-blogged her very first screening mammogram last week. Truth be told, I had meant to mention it a day or two after she first posted it, but it plumb slipped my mind. Maybe it’s early stage Alzheimer’s disease. Whatever the case, I had meant to use her post to point out that, as a breast cancer surgeon, I sometimes forget just how annoying and cumbersome getting a mammogram can be. However, it’s important, especially after age 50, to undergo yearly mammography. It’s also important between ages 40-50, but the evidence for routine screening mammography saving lives in that age range is not as strong.

Actually, though, it was her followup post, in which she discussed the pros and cons of screening mammography based on the patient instructions given to her, that held the most interest for me. Note to self: It may be time to do another post about this subject again soon, using Janet’s posts as a jumping off point. And, no, I’m not going to threaten to live blog a colonoscopy, as PZ did. I still have a few years before I hit 50, anyway.

Comments

  1. #1 John P
    July 30, 2008

    As a man, I’m very glad we don’t have similar screening procedures for testicular cancer. :-)

  2. #2 llewelly
    July 30, 2008

    Truth be told, I had meant to mention it a day or two after she first posted it, but it plumb slipped my mind.

    I blame anti-vax stupid.

  3. #3 Mark P
    July 30, 2008

    Actually, based on my own experience with a colonoscopy, I would be interested in learning how someone could live blog it. I was pretty much out of it during mine, and remained so for some time afterwards, despite my protestations to the contrary.

  4. #4 leigh
    July 30, 2008

    i had a mammogram at the age of 23 in the early stages of diagnosing a tumor. fortunately, in the end we learned it was benign- some of my relatives had a less fortunate experience with breast tumors. i wondered about the point of this, since the tumor was well palpable and obviously present. but the consulting MD required it without question, so i did it. (i no longer use that health system, as a result of my total lack of say in important matters.)

    it’s one thing to be of typical mammography age in the waiting room, but i was sympathetically but pretty openly stared at. talk about a way to increase your stress level through the roof.

    the process itself was painless but rather inconvenient.

  5. #5 Julie Stahlhut
    July 30, 2008

    Mark — they don’t have to knock you out for a mammogram, but it would definitely be awkward to hold the laptop while — er, restrained for the procedure. :-) However, if the techs didn’t mind, and you had a laptop or other internet device with you that worked at the location, it wouldn’t be difficult to blog between images.

  6. #6 laurasf
    July 30, 2008

    Similar question to Leigh.

    My cancer was diagnosed in my 30s because of a large palpable lump. So, what was the point of doing a mammogram, US and MRI when any one of those modalities would have said what they all ended up saying: that I needed a mastectomy? Why couldn’t they have done a bilateral MRI (which they did anyway) and called it a day, and saved me the pain of squishing a breast full of tumor into a mammogram machine? Plus, they couldn’t get a good reading, and redid it eight or nine times. And just the next week my onc told me to avoid doing anything that might squeeze the tumor, I suppose so that cancerous cells wouldn’t be further squeezed into my lymph and blood stream.

    I can’t help but wonder now whether that mammogram might have done me some real harm.

  7. #7 Dave
    July 30, 2008

    Mark — they don’t require you to be medicated for a colonoscopy, and some people do skip the drugs. I did, for example. Not to be stupidly macho, but because I had an event I wanted to attend a few hours later and I couldn’t afford to be sleepy.

    The nurses told me that almost all women do opt for the drugs (Fentanyl and Versed, I think), but a fair fraction of men skip ‘em (somewhere between a quarter and a half of the patients), mostly because they need to go to work afterwards.

  8. #8 Mark P
    July 30, 2008

    Dave, I have heard and read reports of people who suffer severe pain when undergoing a colonoscopy, even with the use of sedatives that essentially knock you out. I remember nothing from mine, but am told that the drugs actually allow the patient to be responsive to directions during the procedure. I wouldn’t care to experience fully awake, although, since you say it is done without medication, maybe PZ will actually live blog it so I can see what I missed.

  9. #9 Julie Stahlhut
    July 30, 2008

    Yikes! When I had my colonoscopy, I was sedated to the point where I was essentially unconscious. I was having another minor surgical procedure done at the same time, so the heavy sedation was necessary anyway, but I really preferred to not be present for the festivities under any circumstances. No problem, though.

    My husband was less heavily sedated for his colonoscopy, but said it wasn’t too bad. We’ve had one apiece (the 50+ checkup), but quite a few of my older relatives have had multiple colonoscopies, and none of them have ever complained of pain during the process.

  10. #10 Lauren Uroff
    July 31, 2008

    Today, I am thankful that I have had my regular mammograms all through my 40s. At 48, I’ve just been diagnosed with IDC. I felt the lump before the mammogram, but since I had just returned to weight lifting, I had attributed the lump to that.

    I start neo-adjuvatant therapy as soon as the CT/PET scan and MOGU scan are done. (I think I have the names right?!)

    Yes, mammograms are painful when you have a brutal or uncaring radiology tech, but I am glad now that I went even though it is painful.

  11. #11 Numenaster
    July 31, 2008

    Thanks to family history of various cancers including breast (my mom), I’ve been on the annual mammogram treadmill since I was 30. My experiences have varied within a range, but in general I think Molly Ivins described it pretty well (quoting another friend, Myra McPherson): If you want to prepare a girl for her first mammogram, you should tell her to go lie down on a cold cement slab in the garage and run a tire back and forth across her chest.

  12. #12 barbie123
    August 2, 2008

    I have had mammograms for several years at many different places; several weeks ago, I had to have an ultrasound and a “compression view” after my regular mammogram showed a suspicious mass; fortunately, everything looks benign so far after further testing.

    I do need to point out, however, that I don’t share Ivins’ view; the whole procedure (regular mammogram and the more intense “compression” view: i.e., SQUASH!) was completely painless. I wouldn’t even describe it as “uncomfortable”.

  13. #13 Diora
    August 4, 2008

    Why “pro’s and con’s” discussion mentioned in the post failed to include any mention whatsoever of overdiagnosis? This is a whole more important risk of screening than false positives.

    Additionally, why wasn’t the information in pro’s and con’s quantified with a) NNS b) absolute risk of false positives after 10 years of screening c) absolute chance of biopsy during the same 10 years? Should we, women, have a right to make a choice (and yes, it is a choice) based on this information and not some meaningless relative numbers like 30% mortality reduction?

    “However, it’s important, especially after age 50, to undergo yearly mammography. It’s also important between ages 40-50, but the evidence for routine screening mammography saving lives in that age range is not as strong.
    It has a very small chance (in absolute numbers not meaningless relative numbers) of saving one’s life, true. But 1/500 (over 50, after 10 years of screening and based on optimistic interpretation of the studies) chance after 10 years of screening comes at a price of almost 50% risk of having at least one false positive and 7-8% risk of biopsy. Plus an increased risk of being diagnosed with breast cancer in one’s lifetime and to suffer complication of this treatment. IMHO – I shouldn’t do anythinhg. I have a choice to make based on this information as to what is more important to me – the small chance of benefitting (tremendously) – for a price or the risks themselves. In my 40s, I decide – no. Not that I am approaching 50, I’ll make another decision. But is it my decision.