Mammograms—a lifesaver or modern torture device?

A treatise on the trials and tribulations of life for Ill-Behaved Women

By LL KIRCHNER

In my junior year of high school, we were assigned a “how-to” speech. For some reason, I thought it would be hilarious to demonstrate how to make cookies using pre-made dough from a tube (a sensation that had only recently hit store shelves and which, at the ripe age of 16, I saw as a sign of the End Times). I thought it would be extra hilarious if I did my demo as Julia Child getting drunk, ruing the demise of real cooking. For good measure I threw in a blood-spurting injury. And no, creating a “character” was not part of the assignment. But I’ve always been captivated by Julia Child.

About two weeks ago, I finally got around to watching Julia, the 2021 documentary about Julia Child, directed and produced by Julie Cohen and Betsy West. An extraordinary testimony to a life well-loved, I highly recommend a watch. Child makes for an interesting subject, especially for any writer who has struggled to produce their work. Did you know that she spent nine years and experienced multiple publishing setbacks before having her first cookbook released? I didn’t.

The film also made far less of her childless marriage than did the 2009 drama, Julie & Julia, which—in my recollection anyway—found ways to shoehorn that fact in at every turn. But then, in 2009 it hadn’t been long since I’d learned that I would never have children. If anything, my reaction may have stemmed from feeling guilt that, unlike the character in the film, I wasn’t racked with grief every time I saw a baby.

The doc spent much more time on the cancer that claimed Julia Child’s left breast. Or in my mind it did. Possibly because I’d just learned there was something suspicious in my left breast. If ever there was someone I’d like my life to align to, it’s Julia Child.

The breast of everything

When it comes to my own chest, I don’t think of myself as having breasts exactly. To my ear, that word imbues a pendulous quality. What I have are tits. High and tight, like a military haircut.

Someone I was seeing once asked if I’d ever considered “getting them done.” For a moment I was mystified. Done how? Then I realized he meant augmentation.

If memory serves, I laughed. Not because I found the idea of surgery all that amusing, or over some holier-than-thou, my-body-is-my-temple notion. None of that. I laughed because, if I could’ve gotten my hands on that kind of cash, there were so many other things I would’ve spent it on first. But he wasn’t joking.

“No,” I answered.

All my powers of reasoning on the matter had gone into deciding — and oh, how I wish I were joking — that the size of my tits precluded stripping or sex work. And while that decision surely altered the course of my life, my tits have otherwise never presented much of an impediment.

Then I reached the Age of Mammography.

From 40 on, it’s recommended that women have annual mammos. (Or that used to be the recommendation, I’ll get to that in a minute.)

It turns out that I, like nearly half of all women, have dense breast tissue. What that has consistently meant for me is that, since turning 40, I’ve been forced to pretend there is some reason to watch nurses attempt to clamp my dense little titties into a vice so that radiation can be shot through them from multiple angles, only to be told my results are “inconclusive,” or “abnormal,” or I HAVE DENSE BREAST TISSUE so when can I come back for additional screening? Bonus, for this second go ‘round I get pay out of pocket!

In the U.S. alone, some 40,869,997 mammographies are performed annually (that’s about 160,000 per day if you factor in weekends). If you haven’t seen a mammography machine, here’s what you’re missing:

Each breast is squashed between the two trays, which clamp down onto the offending organ while you’re asked to hold your breath as radiation is shot through.

Supposedly, the University of Chicago has developed a machine with curved breast plates that purport to add comfort, but I’m skeptical. Like, how does that work? The point is to smoosh the mammary into a pancake for better image resolution. Also, as someone who struggles to find bra cups small enough, I can imagine having to wait while someone yells out, “Hang on, somebody go and look for those flat plates for this one!”

About ten percent of us will be called back for secondary screening.

Only once have I not been called back for additional screening. On the plus side, it’s an ultrasound so it doesn’t hurt.

Tits that time of year

The first time I was called back to the doctor’s office (which was also my first mammogram) I wondered why we didn’t just start with the ultrasound. If it’s getting a better picture, isn’t that, well, better? Has insurance once again deemed my medical treatment as too low priority?

Not exactly.

Sound waves do reveal loads more masses within the breasts, but most of them aren’t cancer. Mammography is basically better at spotting precancerous clusters (calcifications), where an ultrasound, for people with dense breasts especially, can identify malignancies not visible in mammos.

How is it that we can send Jeff Bezos into space but we can’t figure out how to get a decent shot of the inside of a breast? Let’s take a collective moment to ask how this would play out if every man over the age of 40 was hoisting his junk up into a vice every 12 months. Now think about the fact that insurance pays for Viagra, just because that annoys me.

Couldn’t mammography and ultrasound be combined? At least for those of us with the dense breasts, which, near as I can tell, is more like 100 percent of women. Seriously, every woman I’ve spoken to about this tells me that they too have dense breast tissue. According to reports, breasts get denser as we age. And with HRT, which I’ll also circle back to.

This is where the situation grows more complex, because there is such a thing as overscreening.

Let me take a pause here and say that I’m not at high risk for breast cancer. Having grown accustomed to the callbacks, that stress has lessened. The bills have not. This latest secondary screening cost $650. WTH? How is that sustainable? Once is bad enough, but over a lifetime?

As I’ve mentioned, the guidelines for getting mammograms have changed. I always thought it was every year after 40 full stop. Somewhere along the way it changed to after 45. Then to every other year. Then only after the age of 50. Now the guidance is to get a mammogram every other year after 40. I think? Similarly, guidelines vary on when to stop; some say 70, some say 74. (The fact that there’s an expiration date on testing is a whole other depressing matter.)

Despite my regular grousing about the screening, nobody at the breast center ever mentioned a change in guidelines. Meanwhile, I still get letters from my insurance company reminding me to schedule my annual exam. I wouldn’t have found out about this change if I hadn’t turned to Dr. Google, but that was only after the second screening.

When I got the call advising I needed to come back, I had no lumps, felt fine, and figured this was another example of more of the same. Until I got to exam room.

First off, I had another mammo (HOO-rah) as well as an ultrasound. Then they called in a doctor to talk to me. And while these extras might seem like a reasonable explanation for the fact that this visit cost more than double what it ever has before, I was charged before I ever set foot in the office. Regardless, the result of the second screening was a recommendation for a biopsy and another $1200 in bills.

“Small price to pay to know,” you might say. That is, if you are able to afford these screenings.

The office called Friday night. To my relief, the biopsy sample was benign.

But my relief was short-lived. They want me back in six months.

Now I’m left wondering… When is enough enough?

There’s a reason screenings are now recommended only half as often—over a lifetime, the radiation exposure alone can cause cancer. Meanwhile, as a woman with dense breast tissue, I am destined for a lot of false positives.

I’m having a moment something like it felt to discover that HRT wasn’t the evil sin it had been presented as (which I wrote about here and here). Though it was after the fact (because of the bad wrap), I’m glad I started HRT. It’s reversed the bone loss I was experiencing as a result of menopause. Now it turns out I’ve been overexposing my tits to radiation?

Do I go back in six months? What are the chances things won’t seem “suspicious” again? They almost always do.

Then I go back to the Julia Child of it all. She survived her left breast by a good 36 years. That’s a lifetime of love, good food, and good sex. All of which brings me back to wondering, can we not put the money into researching better alternatives for mammographies?

Now for YOUR breast advice

-Do you have dense breasts too?

-Have you ever not gone back after a biopsy?

-What’s your favorite thing about Julia Child?

Get in on my inner circle of Ill-Behaved Women here.