She stopped rolling the ultrasound wand over my right breast. "It's okay, keep going." I said. "Unfortunately, I know what the biopsy involves."
I'd seen one six years ago when I was the support person for K, who sat today as my reinforcement. K is a tough runner and cyclist who can pedal 100 kilometres in a day. Yet I could see pain on her face as the long fat needle pierced her breast. I called it the "ambush biopsy" because she had no idea it was coming.
I was prepared. No pain relief would be offered, save local anaesthetic. I birthed my son without drugs, but have no stoicism for a sober biopsy.
The doctor arrives to tell me microcalcifications have increased since previous scans. A better alternative than ultrasound-guided biopsy today, he says, is mammography plus biopsy. The appointment is set for two weeks' time.
K asks the doctor, "She's worried about pain. Can you give her a prescription for something before the procedure?"
The nurse offers, "How about Rescue Remedy?" This is not the time for placebos. I want chemicals. Pharmaceuticals. "How about Valium?" I ask. The doc says he can't prescribe it, but my GP might.
K and I wait 40 minutes to see the breast surgeon. In the absence of diagnosis, I meet the man who may or may not mutilate my breast. Isn't that like decorating the corner office before you've got the job? This is standard practice.
He palpates both breasts, and I stifle the urge to announce this is the most action I've had in a year.
Two weeks later, breast tissue is once again mashed between two plates in a machine. I'm slightly looped on an expired prescription I dredged up. Once, twice, three times, the tech and radiologist try to position me so they can line up the needle, which never gets introduced.
"The machine doesn't like the position of the calcification," they tell me. "Sorry, you'll have to return another day and we'll try with ultrasound."
Two days later, I'm back again, this time dosed on painkillers for a reason: the radiologist injects local anaesthetic and jabs again, again, again...six times, in total. Thanks to deep breathing, paracetamol, the local, and painkillers, it doesn't hurt. But the needle makes a startling sound, like a hole punch.
It's a six-day wait for results, which are - inconclusive - no evidence of cancer, but no microcalcifications were captured, either. The doctor says while the likelihood of breast cancer in my case is low, it's not zero. The next step is another procedure with a new-ish vacuum device that would spare me a surgical biopsy.
My mom had breast cancer following two years of hormone replacement therapy (shown to increase breast cancer risk). It was caught early on mammogram and 15 years later, she's fine. Her sister, who also had HRT, found breast cancer at a more advanced stage and died after years of chemotherapy at age 64.
We know early detection saves lives, but studies also show breast screening leads to other problems, especially for women under age 50: over-detection, which can mean biopsies, surgery, radiation, drugs, time off work, emotional distress and added costs to the healthcare system for a breast condition that wasn't life-threatening in the first place. I've read this many times before, but never fully recognised, during 13 years of regular mammograms, that they could land me on a treadmill. Until now.
It's estimated testing reduces breast cancer mortality by 20 per cent among women invited to screening. For every 1000 women who have a mammogram in the Breast Screening Aotearoa programme, 42 (4 per cent) will be recalled for further assessment. Of those 42 women, 35 will not have breast cancer, so the screening result for these 35 is a false positive.
The United States Preventive Services Task Force (USPSTF) reports, "Of all the age groups, women aged 60 to 69 years are most likely to avoid breast cancer death through mammography screening." The USPTF says starting mammograms earlier than age 50 and screening more frequently than every other year "may increase the risk for overdiagnosis and subsequent overtreatment". The task force recommends women in their 40s decide whether and when to start screening based on symptoms, health history, family history and individual values and preferences.
An article in the Canadian Family Physician journal last year said, "The goal of screening is to improve health outcomes that matter to the patient, not simply to discover a disease state".
I would never tell anyone with a family history of breast cancer or over age 50 not to get a mammogram. I would say talk to your doctor. Be prepared for what may result from screening. Bring a partner or friend to your follow-up. Keep asking questions, then decide how long you're willing to run the treadmill.
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