posted by meowser
I’ve got a doctor’s appointment on Tuesday. Once a year they make me get a Pap smear so I can keep getting my Kariva (generic Mircette), without which I am a heaping pile of truly debilitating crampage that makes me feel like I’m passing a bowling ball every three weeks, not to mention suicidal PMS and more zits than a gymnasium full of eighth graders. The Pap is no problem. I’m lucky to have a doctor who doesn’t sing me tortured multioctave arias about my weight; he knows I have PCOS and am on antidepressants and there’s not much I can do about either. But he does make a big deal of the fact that I haven’t had a mammogram yet. And now I’m 45. I’m supposed to have had five of them by now. Five.
I have all kinds of reasons for not wanting to get one, besides the default reason of being too lazy. There’s maybe one week a month where I don’t have any breast tenderness at all, and you know, I’m aspie. If the procedure hurts, I am likely to have a meltdown. (I went through hell on an x-ray table a few months ago, when the incompetent tech had me lie on the side where I was already having excruciating pain and kept asking me to “scoot down” not caring that I was already in agony, and took the same x-ray FOUR times because she kept messing it up. Oh, yes, I melted, I melted.)
I do have a stash of Klonopin I can use to stave off meltdown if need be, but I rarely take it because it’s incredibly sedating and staying awake is enough of a problem for me. But maybe I want to be asleep for something like this? I remember Vesta44 saying recently that when she had a mammo, they had to take four separate pictures because of the size of her breasts, and they’ll probably have to do likewise with me. Eef.
But even that’s not the biggest reason I don’t want a mammogram. The biggest reason is that I’m scared to death of what they’ll find, and whether it’s really what they think it is. And according to Sandy’s post on Junkfood Science this week about mammograms, it looks like my worries have some basis in reality. Sandy cites this study published in the British Medical Journal (no, really, read it, your eyes will bug out of your head) that was conducted by a Norwegian research team, in which almost two million breast screenings were examined in multiple countries, and the sentence that leapt out at me was this:
The rate of false positive diagnosis after 10 screenings was 50% in the United States and 20% in Norway.
Okay. First of all, I want to know why they’re doing a better job of eliminating false positives in other countries than in this one. Aren’t we all theoretically using the same equipment? Is there something about American breasts (and yeah, I keep thinking of “Two Wild and Crazy Guys” too, it’s not just you) that makes it harder to screen them? Or are the techs not receiving adequate training? In any case, that brings me to my second point: Fifty percent? Are they fucking shitting me?
All the “FAT PEOPLE ARE COSTING ME PRECIOUS HEALTHCARE DOLLARS BLAAAAARGH” people need to feast their orbs on this particular stat, because this is what’s opera, doc. EVERY woman in America is expected to get a mammogram EVERY SINGLE YEAR from age 40 onward. For an average woman’s lifespan, that could be 40 mammograms. The cost of the screening itself isn’t much, but do you know what happens when they find something? They send you for more tests, and then you have to have a biopsy. All that ain’t cheap. Not only that, the elapsed time between mammogram finding and biopsy results probably engenders some of the worst psychological torment a woman can possibly experience. Am I doomed? Or will I be fine once I go through a couple months’ worth of surgery, chemo and radiation, possibly repeated multiple times over the next few years, assuming I can even spare the money to take the time off and pay all the damn medical bills? Death or generalized weakness and vomiting and pain pain pain PAIN plus losing at least one boob and figuring out whether I can afford to replace it/them surgically and whether I really want to do that anyway? Or is it really nothing and I’m being a big mustard-dripping Oscar Mayer weenie about the whole thing?
I don’t know if there’s enough Klonopin on earth for this.
Oh, and as if that wasn’t enough of a barrel of red plastic lead-infested monkeys, there’s also the fact that a lot of those real positives are NOT invasive cancers, but are largely treated as such, with women having to go through the same surgical, radiological and chemical wringer as for more aggressive forms of cancer. I’m not sure what gives them the idea that surgery, radiation and chemo are harmless for people who don’t critically need them, but shit, they’re not even harmless for people who do critically need them. They don’t make men go through all that for every case of prostate cancer; why is every case of breast cancer treated like some four-alarm fire, regardless of the type? (And talk about needless health care costs, yikes.)
And that’s not even getting into the mucky pool of false negatives. Sandy also did another breast cancer piece a few months ago, in which she cited the findings of British breast cancer treatment pioneer Dr. Michael Baum:
Screening takes place [in Britain] every three years, so it doesn’t tend to catch the fast-growing, aggressive cancers, such as high-grade invasive duct carcinoma and inflammatory breast cancer.
Furthermore, only one in 1,000 women will avoid death from breast cancer over ten years of attending screening.
Maybe I need a bottle of scotch with that Klonopin. Or maybe hash brownies would pose less of an interaction risk, I don’t know.
(If you want something from an American source, Sandy also references the cancer.gov page on breast cancer‘s statement on false negatives: “One in 5 cancers may be missed by mammography.” And these are people who are pro-mammogram.)
I do self-exams every month. Multiple times a month. Always have. But really, talk about gambling with your time and psychic energy. I could be in that 0.1% of women whose life would be saved by a mammo. Anyone could. Breast cancer does not have a strong genetic link; the fact that it’s unprecedented in my family means nothing. (And how do I know that one of my pre-mammogram ancestors didn’t have one of the noninvasive forms of cancer that never caused her any trouble, and so never even knew it was there?) On the other hand, there’s also no consensus that premenopausal breast cancer is any more common in fat women than thin women; in fact, some experts think fat women get it less often. (That link has other interesting factoids in it, like the finding that tall women — 5’9″ and up — are more prone to breast cancer than shorter women. Though I’m not sure how you’re supposed to “maintain a body weight that is neither too thin nor too fat” any better than you are supposed to make sure you don’t grow to be “too tall.”)
But getting the mammo is chancy regardless. Do I really want to know what it says? Not to mention the fact that once you’re diagnosed with cancer, your “healthy fatty” privilege goes out the window. If a thin woman gets breast cancer, it’s random bad luck; if a fat woman gets it, it’s because she’s a self-destructive oinker. But really, if it weren’t for the ridiculously high inaccuracy rate, I’d probably go anyway. If I have to be put through the wringer because I’m truly ill, so be it, but the prospect of going through the wringer for nothing is what gets me. Not to mention the fact that women are relentlessly pressured to do so. Year after year between 40 and death. How long can I hold out?