Monday, March 5, 2012

Making Mammograms More Comfortable

Well, I recently went and got a mammogram.  Good times.....not!  But really, it wasn't too bad this time, and that was a welcome change.  I'd been putting it off because I'd had some bad experiences with mammograms before, so the fact that it was pretty easy this time was a great relief.

So the experience itself was okay, but I was on pins and needles waiting for the results. I won't keep you in suspense...the good news is that the results were normal.  Huzzah!

What's the big deal, you ask?  The big deal was that I hadn't had a mammogram in a long time, a controversial thing for a woman in her 40s.  Tsk, tsk!

Deciding when and how often to get a mammogram is such a personal and difficult decision, and one we don't talk about enough as women.  Moreover, it's one in particular that we fat women don't talk about I decided to bring the discussion up here on my blog.

This will be a two-part series, and I encourage you to share your own experiences with mammograms in the Comments sections.

A couple of caveats first.  First, I don't pretend to be an expert on breast cancer or the pros and cons of screening. Frankly, I'm still learning about the subject. Please always do your own research and consult your own healthcare providers.

And second, please note that I'm certainly not trying to tell you what you should do about screening in your life.  All I want to do is open a dialogue about breast cancer screening, what that means for us as women, and what that means in particular for us as fat women.

This will be a two-part post.  Today's part will discuss my own experience with mammograms and trying to improve the experience.  The next post will discuss the controversy over screening guidelines (when and how often), and how "obesity" may or may not affect screening frequency choices.

Background Info

I should give you a little background to understand my decision-making process on this.  I had a number of mammograms in my 20s and 30s because I have fibrocystic breasts that are chronically lumpy. This makes doing a self-exam difficult because there are always lumps there, and they frequently go up and down in size and tenderness.

Not having any access to my family medical history because I was adopted, I have had difficulty deciding how aggressive to be about such lumps.  They are quite likely to be benign, but since we couldn't know if there was any family history of early breast cancer, we didn't know how seriously to take them.  So I'd been through a number of mammograms already by the time I'd reached 40.

And frankly, some of those mammograms were very unpleasant experiences.  Some squeezed so hard I was in a lot of pain.  Others had very insensitive mammogram technicians and I found the whole process incredibly humiliating.  Not exactly the kind of experiences that encourage you to want to do more testing.

I remember one mammogram in particular in my late 20s.  The screening facility was for all kinds of diagnostic tests, so men and women were mixed together in the waiting area and in the halls.  They had me take off my shirt and bra, put on a gown that didn't fit very well, and then walk down a bunch of halls, past all kinds of men staring at me as I walked by, bra-less and in an ill-fitting gown.  I tried to cross my arms and walk slowly so there was less jiggling, but that was hard when I was trying to hold the damn gown closed and the aide was trying to hurry me down the hall.  I was absolutely mortified. I'm not just a little busty, I'm a lot busty, and walking around like that was very embarrassing, and honestly, very physically uncomfortable.

And then the ultrasound tech wasn't prepared for someone well-endowed.  After looking me over, she decided the plates weren't big enough, so she went to the doorway and shouted down the hall for another technician to bring her the "really large" plates.  OMG, I wanted to sink through the floor at that point.  And then there was the considerable pain of the mammogram itself, followed by the jiggling walk of shame back to where my clothes were.  Not the worst experience in the world compared to other experiences you could have, but not positive for someone who had an insecure body image at that time.  When I left, I was in tears.  I didn't go back for a mammogram for quite some time after that.

To be fair, not all my mammograms have been bad.  Some have been fine.  And I'm a lot tougher emotionally and mentally now than I was then, so I am less afraid to stand up for myself and find ways to make the experience a bit better. But the negative experiences I have had have left an indelible impression and make me more reluctant to get regular screening.  You just never know which type of experience you're going to have.

I did get a mammogram in my early 40s because I wanted another child and needed to make sure all was normal before proceeding with another pregnancy.  It wasn't a horrible experience, but it still was fairly painful.  Again, not something I looked  forward to doing.

After my child was born, I was too busy taking care of four children and my dying mother to bother with a mammogram for a long time.  My mother  had sooo many doctor appointments and  hospitalizations that I really needed a break from all things medical for a I procrastinated getting another mammogram.  So when the US Preventive Services Task Force came out with their statement a couple of years ago, saying that it was okay to wait till 50 to start regular mammograms, I was a willing audience for that message.

I finally got the mammogram this month because I'm now in my 50s (gulp!) and it's officially time to start all those lovely screening tests.  Also, I have had 3 women in my circle of friends and family be diagnosed with breast cancer in the last couple of years, and I've seen firsthand how this has devastated their lives.  I know this cancer is very survivable if found early, and that's certainly a potent motivator for getting screened.

But what finally got me going on the mammogram is the fact that I have an enlarged lymph node under my chin, one that has been persistently enlarged for some time now.  It's probably just fibrotic tissue from a really bad bug I had a couple of years ago...but it might not be.  When I brought this up to my GP, she didn't panic but did note that this could be a symptom of cancer somewhere and we should rule that possibility out, despite the fact that my bloodwork is all reassuring.  She pushed me to get the mammogram going (I had already scheduled one at that point) and to do some other testing (a colonoscopy, oh joy).  If both of those are negative, then we can wait a bit longer and watch it, or decide to do a needle biopsy of the lymph node, just in case.

So I bit the bullet this month and went and got my mammogram.  And I'm thrilled to say that it actually was a pretty decent experience.  And of course, I'm even more thrilled to say that my results were normal.

Improving the Mammogram Experience

So what did I do to make the mammogram experience better?

First thing I did was schedule it in a lab that only does mammograms etc. so I was very unlikely to be dealing with men waiting around in the facility too.  Doing it in a place that specializes in mammograms also increases the chances that their techs really know what they are doing and can minimize discomfort.  So that's my top recommendation to others.

Second, I scheduled it during the first 2 weeks of my menstrual cycle, about a week or so after my period, when my breasts are less sensitive.  This made a huge difference in my pain levels.  So scheduling the timing carefully is also a major recommendation from me.

[Someone also suggested that I take ibuprofen beforehand, but I forgot to do that, and honestly, was fine without it.  Another common hint is to avoid caffeine for several days beforehand, but since I don't "do" caffeine, this wasn't an issue for me.]

Third, when told to take off my top and bra, I told the aide that I would be keeping on my bra for my own comfort level and would take it off once I got to the testing room.  They were a little surprised but didn't argue or hassle me about it, and the mammogram tech was also fine with it.  That was a small thing, but it really made a difference in my emotional comfort level.  I had no idea before that it was even an option...but I will do it every time now!

Finally, I told the tech that I'd had some very bad experiences with mammograms before and I was trusting that she'd help me have a better experience this time.  She was sympathetic and took a bunch of time to explain how the machines had been greatly improved since the last time I had a mammogram and now used less force and less squishing.  She was honest and said it would probably still be uncomfortable at times, but would probably not be nearly as painful as in the past.....and she was totally right.

I still find the experience embarrassing, mostly because there's no getting past the fact that a stranger is handling an intimate part of your body as if it were a slab of meat, pushing and pulling and hauling it all over to get the pictures just right.  I don't think I'll ever be "fine" with having any part of my body handled like that.   Gah!  But she was very matter-of-fact about it, which was helpful, and I know she was just doing what she had to do so we didn't have to repeat any pictures.

And in the end, the mammogram was much shorter than it had been in past years, MUCH less painful than it had been in the past, and really wasn't that big a deal.  I was in and out of there very quickly, and all was well.  HUGE relief.

Bottom line, I will be less likely to avoid mammograms after that experience, compared to my previous experiences.  And that's really important now, especially at my age, when frequent screening becomes part of the landscape.

Next post: The Mammogram Screening Debate for Women in Their 40s


General Information About Mammograms
Improving the Mammogram Experience 


Kate said...

I recently had my first mammogram, I had just turned 40 and my GP was really pushing me to do it. He recommended a nearby hospital. I went with the hospital because I had a previously good experience there with a procedure in that they had very large gowns and I had not experienced weight shaming there except from one person. They also had a special area in the hospital just for mammograms.

I really had no idea what to expect other than pain. Like you, I scheduled it for just after my period, not exclusively because of sensitivity, though that was a consideration, but because they wouldn't let me have one without a pregnancy test if I was in the second part of my cycle.

I really liked the tech, she explained everything that was going to happen, but the one thing I was completely unprepared for was how much I'd be touched. I really hate being touched so that was mentally upsetting. She didn't say anything about my weight and only said she'd have to take two shots per position due to my breast size.

I don't have any breast cancer in my family that I know of. I can go back only 2 generations on my mom's side, but several generations on my dad's side, so I find it hard to believe that I'll get a mammogram every year, even though that's what I was told was recommended.

Janeen said...

This is good to read because I have a lump that is being watched currently. I've had it since October and was told to go in for both a mammogram and ultrasound. Well, this time, only an ultrasound was done and they got enough from that that they didn't need to do the mammogram but I'm to go back in two months to check it again. I was told it was very likely benign and due to trauma (my current nursling keeps grabbing at that area while nursing like it's a cup or something and that is probably what is causing the trauma). But still, glad to read this so that I can be prepared in case they do decide to go the mammogram route the next time. My great grandmother died of breast cancer back in the 1950s. She did not go in until it was much too late (whole breast was hard at that point). She was in her 60's though so I guess it was a post menopausal deal but still, probably something I should be aware of all the same.

BusyBeingFabulous said...

My mom had breast cancer at 49 pre-menopause. I had lumps 2 yrs ago at 30 so I had a mammo. I went to a women's only breast center. I never thought about keeping the bra on until the last min but I bet I do it next time! I did wear a scarf. It felt more modest plus it was warm & cute. I nursed twin boys exclusively for 23 months until they weaned (a year before the mammo). We had every nursing road-block known to man so we were at the ped's Lac Nurse often. I was used to being handled! I also have fibromyalgia so the pain of the squishing was nothing compared to the pain I deal with continuously just living. They ended up bringing me back for an u-s & biopsy. It was uneventful too. I told them I don't want to see what you're doing, I don't want to know what you're doing it with & I want to know as few details as possible. I knew the lump was all the way down so the less I knew the less I'd worry (or be grossed out)!

I really enjoyed your PCOS series btw!

Oxygen Therapy said...

Really Good Blog on mammogram alternative It good to see an honest account and you talking real sense too. Great!

ann said...

just wanted to pipe in and say that men get breast cancer, too!
good for you for taking care of yourself!

kindness said...

Even though this is an older blog ,I appreciated it very much .I had a mammogram yesterday and I was a little neverous,but , OK about it. Even though I have been very ill for many months and have lost a great deal of weight . I have had them before and only one that was very painful.Well ,I was wrong , I should have been more aware of what was happening ,especially ,being older I should have STOPPED the test the minute it became so painful I became nauseated it was so painful . I know I was thin and that could have been the cause of so much pain
,but , for me, it is MY Body and I would Never want a test done that is so terribly painful that
may cause untold damage, to maybe save me from something that I may not have. I have had painful test done in my life, and I have always wanted to cooperate and just bear it ,I 've gotten pretty tough over the years. But, I have
never had a mammogram so painful in my life. Needless to say , it will not ever happen again,I will NEVER have another one done there. I will wait until they get the heat imaging screening in our area . So very Sad, as it was said in the blog , some people just are not trained well, even though this person said they had been doing them for 20 years, which is a shame how many people have they scared away from getting this life saving test done.