Is It Too Late For Mammogram Screening?

'It was time for my annual mammogram screening but I decided enough is enough.'

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It was time for my annual mammogram screening but I decided enough is enough. I was, after all, in my eighties, had done due diligence for over forty years; surely I deserved a reprieve. To counter my family’s objections, I summoned evidence that breast cancer in older women is typically slow-growing, other conditions more likely to take us to our maker. What’s more, if older men with prostate cancer are spared treatment, why couldn’t I be granted the same pardon? “Because prostate cancer and breast cancer are two distinctly different diseases,” my sons scolded. “Studies indicate that screening for low-grade prostate cancers show nearly equal survival rates with or without treatment. In contrast, elderly women treated for breast cancer have a 90% survival rate as opposed to 46% for those who forego treatment.”

These data gave me pause . . . briefly. I then argued that the American Cancer Society, no less, conceded that mammography, while lifesaving, still remains an imperfect instrument. False positives—suspicious findings later proved to be harmless—often lead to more tests and in some cases needless biopsies. In turn, they quoted Dr. Clifford A. Hudis, who served two decades as chief of breast cancer medicine at Memorial Sloan Kettering Cancer center: “The harm of a missed curable cancer is something profound. The harm of an unnecessary biopsy seems somewhat less to me.”

To silence my hectoring children, I reluctantly agreed to ONE LAST mammogram screening. In the clinic waiting room, I sat among a sisterhood of women wrapped in flowered smocks covering young breasts, wholesome and fertile. They still have half their lives ahead of them, I mused. What in heaven’s name am I doing here? After a routine exam and routine screening, I awaited a routine report. But this time I was called back for another picture, and another and yet another. “What’s going on?” I dared ask. “Oh, the doctor wants to rule out any irregularities so she’s ordering an ultrasound.” My heart hammered as the ultrasound probe zigged and zagged, searching for abnormalities. The room was silent, cold, airless. No one spoke . . . only breathing. “Can you please tell me what you’re finding?” I asked with a new urgency. Answer: “Please get dressed and meet the radiologist in her office.” There she pointed to an image which showed an irregularity. “I like a smooth, boring picture,” she said, “and I’m not seeing one here.” “So w . . . w . . . what’s next?” I stammered. “Well, it may be nothing, but it needs more attention so I’m ordering a biopsy at the women’s center.”

“It may be nothing,” I repeated to myself like a mantra. “It may be nothing.” At the same time, I was imagining a rapidly metastasizing cancer, breast surgery, chemotherapy, loss of hair, loss of dignity, perhaps loss of life. My husband reminded me that the jury was still out regarding a final outcome. “Let’s wait for the biopsy results and we’ll go from there.” I’m too old for this, I thought. Women my age have heart attacks, they fall, they lose their minds . . . they don’t have breast cancer.

During the biopsy, a titanium chip was inserted to guide the surgeon to the suspicious site with precision, should surgery be necessary. I was intrigued by the idea of a titanium marker lurking in my body for the balance of my life. Would it light up at night? Would I be sidelined by airport security? This is surreal, I thought, here I am at a possible life/death crossroad and I’m ruminating about a titanium chip. When the tissue was ready for lab analysis, the radiologist mentioned as though delivering a weather report, “the tumor is small and it’s cancer.”

The following day I hovered by the phone, braced for the verdict. A call pitching Caribbean cruises came with ironic frequency. Finally a young doctor announced apologetically that the lab test showed a small carcinoma, apparently low-grade. I was oddly relieved. Small, low-grade, it’s all relative. I’m actually celebrating a cancer, I noted incredulously.

Next, a consultation with the surgeon. A kind, elderly gentleman carefully reviewed the phases of standard care for breast cancer. In my case, he would perform a lumpectomy, remove only the tumor, and biopsy the sentinel nodes—those near the breast—testing whether cancer cells had entered the lymphatic system. Follow-up treatment would likely involve a brief period of radiation along with hormonal therapy to suppress cancer recurrence. “How long will the hormonal treatment last?” I asked. “Five years,” he shrugged. “FIVE YEARS!” I shrieked. “I may not be alive in five years.” “You’ll be alive a lot longer than that,” he said with an avuncular grin.

The tumor was removed in a ninety-minute procedure. I was home the same day, impatiently awaiting the lab report. After several anguished days without a phone call, the surgeon informed me that the tumor was small, the surrounding margins “clean” and the sentinel nodes showed no pathology. A better report could not have been imagined.

Following surgery, I learned from my oncologist that the tumor, though small, was indeed an aggressive one. Thus, in the eleventh hour, a fast-growing cancer was removed in time by dint of a routine mammogram I had been too willing to forego. Who among us would not trade a few hours at a women’s clinic for at

least 120 months of fully lived tomorrows?

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