Beyond the basics – It’s mammogram time!

mammogrambeyondthebasicsSo you’ve been doing your Breast Self Examinations ever since you had your first visit to the gynecologist and learned the proper way to do a breast self examination? Right? Right. Good girl.

As twentysomethings we hear tell of mammograms and file them into that “Things Old People Have to Do” box and kind of forget about it. As thirtysomethings it occurs to us that we might be getting mammograms before long. By the time we’re about to turn 40, and that first mammo is no longer in the distant horizon, we decide that they’re not actually for old people. Because we need to get one, like right now, and we’re not old. Mammograms are thus reclassified as “Things That the Young and Lovely Must Do.” There, that’s better. Ready to find out more?

• The American Cancer Society and the American College of Radiology recommend annual mammograms, along with monthly BSEs, for women 40 and older. In addition, women should have a health care professional do a clinical breast exam, or CBE, at each gynecological appointment. You know the drill Pap smear, CBE, blood pressure, the basics. If you have a first degree relative who has had breast cancer, start annual mammograms starting ten years prior to the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40).

• The U.S. Preventative Services Task Force has a different set of guidelines, recommending mammograms not begin until age 50, unless a woman is at high risk, and then only every other year. It also doesn’t recommend BSEs. Most doctors, however, continue to recommend mammograms for women 40 and older, and also monthly BSEs.

• You will be guided to schedule your mammogram for early on in your cycle, so that you don’t have premenstrual swelling and lumpiness. I don’t know about you, but I don’t want anything or anyone near my breasts, or, heck, near me at all, in the last week of my cycle. Avoiding late-cycle screening will ensure both a clearer image and a more comfortable procedure.

• On that note, if you get extra lumpy when you have caffeine, you may wish to skip your cappuccino the morning before and the morning of your exam. Unless it turns you into a complete crank monster, in which case please do not skip your coffee if you are someone I know.

• Will it hurt? The improbable concept of flattening one’s breasts into the thinnest possible pancakes is enough to make many women cringe. Some women do find the process uncomfortable, others find it awkward, and probably a few people find it fun. I do not find it painful mostly awkward, what with pieces of plexiglass poking me in the armpit and all, and kind of funny. Making small talk with a very nice person who is squishing your breasts onto a giant machine is kind of amusing.

• So here’s how it goes: You put on a gown, and you and your breasts are placed in a variety of awkward but generally painless positions, and several images are taken. You will be directed to wait while the pictures are reviewed to ensure that the best possible image is available for the radiologist to read. Then you get to go home. And wait.

• So how about the anxiety? Some people get very anxious about the procedure both the physical experience and the possibilities of getting bad news. It’s nerve-wracking for some people, just waiting in a very pretty room with lots of glossy magazines and several other women who are waiting, waiting, waiting, just like you. But once the mammogram is over, you can go home and forget about it. Or not. You can worry about Bad News.

• The good news is that there is rarely Bad News, and when there is Bad News, it usually turns out to not actually be Bad. False positive readings are not uncommon. About 10 percent of women will get the scary phone call telling them to come back in for a diagnostic mammogram or ultrasound to get a clearer image of the breast(s). Of that 10 percent, the vast majority around 90 percent turn out to be benign cases. The other 10 percent (or 1 percent of all women who get mammograms) will need to get a biopsy, and while about a third of the biopsies will show some sort of cancer, it is usually one of the lower (less invasive) grades, caught early. So even if you get the dreaded phone call, odds are on your side that everything is fine.

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