Tied Up in Knots about Mammograms? Join the Club
The opening sequence of Nicole Holofcener’s “Please Give” is a laugh-out-loud montage that rings poignantly true to any woman (and that’s most of us over fifty) who dutifully puts herself through the annual or biannual torturing of the breast otherwise known as a mammogram. To a backdrop of the Roches singing “No Shoes,” breasts in all sizes, all shapes are pinched and positioned for that no-smile (don’t even think of saying ‘cheese’), hold-your-breath picture.
In a film that is as much about love and guilt and responsibility as it is about the way the smallest gesture can make a difference in someone’s life, poking some fun at a procedure that is anything but matter-of-fact imparts a touch of irony. It is the job of the X-ray technician, in this case, Rebecca Hall, to get it right. She does the best she can.
Cut to a small waiting room in a large medical group, Anywhere USA. Three women are seated, no eye contact. One is reading a book, another filling out an intake form. The third, yours truly, is riffling through a magazine, trying to make sense of words I’m having trouble reading.
Down the narrow hallway there is laughter, the camaraderie of technicians on a break, which should reassure me of their humanity. But there’s something about being in this room, with its cheerless furnishings and walls painted a color you forget the minute you’re out of there, that makes waiting itself an act of survival.
I should be better equipped to deal — with all those good breathing skills I practice and the 1 mg of Lorazepam that I save for times like this. And yet, anxiety, by its very nature, is rooted in something unknown; the waiting — first to get the procedure over with, then to get the results — only makes it worse. If there’s any reassurance to be had, it’s in knowing I’m not alone in feeling the way I do.
A woman, just out of the X-ray room, takes a seat next to me. She breaks the ice, tells me about her daughter, high-risk but so far/so good, and her own health issues. She has reason to be thankful for screening procedures, despite the anxiety they give rise to. It’s hard to disagree, and yet, looking around the room, all of us in loose medical gowns that hide nothing, really, I imagine every woman saying to herself, ‘please let me not be called back in for another X-ray.’ Even if it’s just for a clearer picture. Please let it not be me.
It’s a vicious cycle: anxiety over breast cancer sends us for mammograms, which in turn give rise to an anxiety that some say may outweigh the benefits. And yet the abstraction of statistical odds is no measure against the power of one, you know the story well, a woman alive today because of early detection. So ingrained is the ‘mammograms save lives’ message that studies questioning their value in an era of improved treatment throw us off.
You do the math: back in 2010 the first major study to weigh the benefits of mammography in a time of vastly improved treatment concluded that state-of-the-art treatment, coupled with mammograms for women 50–69 years of age, reduced the death rate by 10 percent, in contrast to the 15–25 percent it was decades ago; for women over 70 who availed themselves of new treatment but no mammograms, the death rate fell by 8 percent.
Factoring into the ongoing debate over guidelines is the anxiety induced by false positives and overdiagnosis, coupled with age. Should women begin getting mammograms every two years at age 40, 45, or 50? Is it time to rethink annual mammograms for women over 70?
For a woman of a certain age (70+), responsibly attuned to the rhythms of annual mammograms, breast cancer awareness month is mostly a reminder of loss and survival. Everybody goes pink in October, and I go blue. I lost a very dear friend to breast cancer too many years ago to count. Two other very dear friends I thankfully count as models of survival. Blue is as much about sadness as it is about serenity and inspiration.
As it happens, the first breast cancer awareness ribbon was peach, not pink, the symbol of a grassroots campaign started by Charlotte Hayley in the late ’80s. Hayley, an activist battling breast cancer herself, attached the ribbons to cards imprinted with a message: “The National Cancer Institute’s annual budget is 1.8 billion US dollars, and only 5 percent goes to cancer prevention. Help us wake up our legislators and America by wearing this ribbon.” She handed out the ribbons and cards at her local supermarket and also sent them to prominent women.
Self Magazine got wind of her campaign and asked to use the ribbon in a story for its second annual Breast Cancer Awareness Month issue that would promote Haley’s efforts. Haley refused, claiming it was “too commercial” for her. Self went with a pink ribbon, enlisting Evelyn Lauder, who would distribute it at cosmetics counters in stores throughout the U.S. Pink was also the color of choice for ribbons handed out to participants in the Susan G. Komen Breast Cancer Foundation’s Race for the Cure.
I’m not cynical enough to think that awareness is anything but good. Nor am I the first person to suggest that the commodification of breast cancer has gone too far. Prevention, to the degree that it’s possible, is the point.
We take our risks as we choose, or as we’re prone to in a primitive survival sense. I drink wine, a safe amount by some standards, too much by other standards. I eat a healthy diet. I exercise regularly. Coffee, I read, may actually be good for me. Until another study tells me it’s bad.
My particular anxiety has as much to do with a sense that mammograms are looking for something I’d rather not see as with the collective reality that we’re programmed, maybe even manipulated, into believing that what is ultimately out of our control is controllable or at least manageable. Fear is much too effective a motivator for taking action.
The technician calls me back into the X-ray room, uh-oh. She has learned not to show alarm, the truth being there may be no cause at all for it. And yet those heart-pounding minutes of waiting — again — for the radiologist’s reading (nothing suspicious, she will, thankfully, tell me) seem like a lifetime.
