The first mammogram is a simple rite of passage

Like many women, I postponed the first mammogram. Kaiser Permanente began to bother me to make a reservation about 13 seconds after I turned 40. It was 2018.

But then my mother was diagnosed with uterine cancer. I have been promoted to a tougher position. My husband has changed jobs. And I admit that I’ve avoided doctors since I broke my shoulder five years ago. (7 months x-ray and physiotherapy will do it for you.)

For two years I accepted the excuse of being “too busy”. Until the editors here in Colombia encourage you to make a long and late promise and write about it. I agreed to expose everything in the hope of persuading me to get the mammogram as well.

Appointment

The reservation was easy. I was able to set the time and place online. I could even have chosen to go on the weekends.

I received an email urging me to wear a mask, explaining everything I shouldn’t do, such as wearing deodorant or lotion. Photo editor Amanda Cowan has come to record my mammogram. Both she and I experienced the challenges of COVID-19 safety procedures, such as temperature checks and questions about traveling abroad.

I was nervous that morning and changed my clothes three times. But I had to exchange it for a hospital gown anyway, so it didn’t matter what I was wearing. (For mammograms, you need to strip naked from above, so you can wear something that’s easy to take off, skip dresses and jumpsuits, and at least keep your pants on.)

Radiologist Jenni Barr took me to the process, which is really easy. It mainly involves standing still and holding your breath while one breast is being compressed at a time. The bar helped me arrange the imaging machine so that it could do the job.

Women with big breasts (I’m 38DD) were said to be more painful with mammograms. My mother, who has cystic breast tissue, constantly complained of pain during her screening. I thought it would be miserable.

But it didn’t hurt much. Each of the four images took less than a minute to capture. The whole appointment probably took 20 minutes, and it lasted that long as I was asking a question for this article. The pinch and pressure were unpleasant, but not painful. The most painful thing was trying to take one of the images with the left arm and shoulder folded in the correct position.

“It’s really very rare for someone to have a painful experience,” said Dr. Belinda Holland, a Portland-based Kaiser radiologist.

She recommends making an appointment early in the menstrual cycle and taking Tylenol before the appointment if it seems necessary to relieve the pain. If the compression of the machine causes pain, tell the technician, she said.

The most amazing part of my screening was feeling how exposed I was. I think the next mammogram will be less stressful as the photographer will not tag it.

Recommendations

Not all experts agree on when a woman should have her first mammogram. That’s how I rationalized my delay. The US Preventive Medicine Expert Board recommends that women start screening at age 50, while the American Cancer Society recommends starting screening at age 45. However, most doctors instruct patients to screen at age 40.

“In general, for most women at standard risk, starting at age 40 is the most protected,” the Netherlands told me in a telephone interview after my appointment. Breast cancer rates in women aged 40-45 are about twice as high as in women aged 35-39.

In Clark County, the numbers are stunning. According to the latest 2017 figures available from Clark County Public Health, the proportion of breast cancer in women under the age of 40 is 15.7 per 100,000 population. For women in their 40s, the percentage is 166.3 per 100,000.

Holland — and Kaiser Permanente — recommend annual mammograms, even during a pandemic. She said that choosing a date for birthdays, holidays, and car tabs to be updated is less likely to be forgotten.

The Netherlands also emphasized the importance of talking to your GP.

“Everyone has a different story,” she said. Your doctor can help you determine if you are at higher risk and should be screened even before the age of 40.

Risk factors include a family history of breast cancer at a young age, a BRCA mutation, or chest radiation for Hodgkin lymphoma as a child. However, 75% of breast cancer diagnoses are women with no family history of breast cancer.

At the end of my appointment, the technician told me that it was not uncommon for a radiologist to see something on a scan. This is not a reason to panic.

“The first mammogram doesn’t tell us what a normal mammogram looks like,” said the Netherlands. “That’s why we are especially careful.”

About 10% of women are called back for more image processing, but radiologists usually check the scan and provide results on the same appointment.

“The majority will be normal,” said the Netherlands. “Occasionally, you may find something that recommends a breast biopsy.”

In my case, I got the good news within a week. The mammogram was normal.

Now let’s write a note on my calendar for next year’s screening.