The BDN Opinion section operates independently and does not set news policies or contribute to reporting or editing articles elsewhere in the newspaper or on bangordailynews.com.
Jean Hay Bright of Dixmont is a retired journalist and a semi-retired farmer.
Breast cancer is the second leading cause of cancer deaths in women, and every October, Breast Cancer Awareness Month, an effort is made to convince more women to get a mammogram.
But while today’s science around treating breast cancer is truly remarkable, its primary diagnostic tool, the mammogram, is woefully, and dangerously, inadequate.
Breast cancer research is advancing rapidly. A cancer specimen from each patient can now be tested directly, microscopically, to find its vulnerabilities — to specific chemo cocktails, radiation regimens, hormone and/or other drugs — to precisely develop post-op treatments to clear out any remnants and forestall recurrence.
But a diagnosis must come first. Right now, that means getting a mammogram, where each breast is compressed between two flat plates, to spread the tender appendage for a better X-ray image. In many women, that flattening hurts. A lot. Articles about how to deal with sore breasts after a mammogram admit that the pain is keeping some women from coming back. Yet the device has not changed much in decades. (Digital scans and 3D imaging still require compression.)
I had my last mammogram about a decade ago. The first breast scan was gritted-teeth tolerable, but the second breast was only half-way compressed when I screamed “stop!” The pain had reached a level 10, the worst ever. Could the technician not compress as much? No. Could she at least process the scan of the first breast? “It is both or not at all,” she said. I considered what damage that intensity of pain was telling me, and bailed on the session, never to return.
I rationalized it didn’t really matter because that mammogram would most likely have been “inconclusive,” like my previous one, because I had been notified that I have dense breasts. On a mammogram screen, dense breast tissue shows up looking very much like cancer clusters.
I long thought I was in a small dense-breast minority of women, but I recently learned that about half of women over the age of 40 in the U.S. have dense breast tissue. That means mammograms are useless for about half of the patients it screens. Not surprising then that only about 60 percent of all breast cancers are first diagnosed via a mammogram.
A medical device that can produce a clear, workable, diagnostic image only about 50 to 60 percent of the time seems like a technology and engineering failure.
In March, the Food and Drug Administration finally announced new federal rules requiring mammogram providers to inform patients about the density of their breasts, which have been identified as a risk factor for developing breast cancer. In order to properly detect the disease, the agency said additional screenings may be required. Their recommendation? Well, just further testing. An ultrasound, a PET, an MRI if you can afford it or have insurance, whatever. Ask your doctor.
Last winter, my primary doctor talked her stubborn 75-year-old patient into getting a breast MRI, just to be sure. My dense breasts got the Medicare Advantage insurance pre-approval. And, low and behold, the MRI found something. An ill-defined wedge-shaped mass, with a thin and wide leading edge closest to the skin. Even knowing where it was, it was not obvious — feeling something like the thin wide edge of a cracker under a thick cloth napkin, not at all like a lump or a mass.
A lumpectomy in May (“bigger than it looked on the MRI”) was followed by a mastectomy in June, four weeks of radiation, no chemo (per those great lab tests), and now hormone pills.
I know I am lucky. Thanks to my pushy doctor and complicit insurance, I am on the mend. But I am still angry about the state of the technology behind getting to the diagnosis.
For starters, mammograms should not hurt. Women have been complaining about the pain for decades, their voices ignored. Next, women should be warned that mammograms are useless for half of us, and to take those dense-breast notifications seriously.
Finally, more of those scarce research funds should be directed to finding better, reasonably priced, user-friendly ways to screen and diagnose.
Technology and engineering need to catch up. And fast.
