Author Topic: Ladies - mammograms  (Read 9599 times)

BeanCounter

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Re: Ladies - mammograms
« Reply #100 on: May 23, 2019, 06:59:59 AM »
I went to see my PCP last week for my annual wellness (Iím 41) and she said I could move to the new guidelines on paps which is every three years. Yeah! (Of course my GYN was happy to do one every year) I had my first mamo last Dec and I intend on doing them every three years regardless of what my doc says.
She did say that the recommendations are changing on colonoscopy and they are recommending people start them at 45. And then every 5-10 years depending on risk up to age 70. Iím hesitant but will probably follow that recommendation. She also mentioned that it will take awhile for the insurance companies to catch up to this new recommendation to start at 45.
I expect that if/when the US moves to a national health system these testing recommendations will start to drastically change.
Having watched my mother go through two stem cell transplants for blood cancer and later more chemo and then dying from blood cancer, Iím not sure I wouldnít choose palliative care instead of treatment for whatever I am eventually diagnosed with.
I think Atul Gawandeís book Being Mortal should be mandatory reading for everyone over 40.

Cassie

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Re: Ladies - mammograms
« Reply #101 on: May 23, 2019, 10:00:39 AM »
I think colonoscopies at 45 only makes sense if you are high risk.   I know a few people that mammogramís found their cancer early and they lived for many decades so I think itís worth it.

freya

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Re: Ladies - mammograms
« Reply #102 on: May 23, 2019, 04:44:56 PM »
I know a few people that mammogramís found their cancer early and they lived for many decades so I think itís worth it.

This speaks exactly to Beardog's point, and it's why I've been resisting mammograms.  I'm more afraid of a false positive detection resulting in unnecessary surgeries and radiation/chemo, which carry significant risks of things like permanent nerve injury.  The false positive detection is far more likely than a detection of truly aggressive cancer, so a large proportion of stories about mammograms saving lives are actually no such thing.

Beardog thanks for the cochrane reference.  For more info, check out the Canadian and Finnish studies that did not show any benefit for breast cancer mortality from mammography.  Only the New York study did, and the result was due to a population bias that was evident from the very start of the trial (as in, there was a difference even before the first mammography was done).  I'm actually kind of amazed that mammography ever found its way into medical practice, with data like that.  It was really more about the politics than science.


Abe

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Re: Ladies - mammograms
« Reply #103 on: May 23, 2019, 09:27:44 PM »
Mortality from breast cancer before effective chemotherapy and surgery (before the 1970s) was high. This is partly due to the fact that before mammography, most cancers were detected by feeling them. At that point a sizable fraction had spread to distant parts of the body, which is almost always eventually fatal back then (and still often fatal now). At the other end of the spectrum, small slow-growing cancers that couldn't be felt probably wouldn't result in death in a short time frame, so women died of other reasons as the life expectancy was somewhat lower then. These second type of cancers are much more common.

The question then becomes, if mortality is not improved by mammography, especially since we are good at treating early cancers, is there a point to doing it? We have good data on the risk distant cancer recurrence (Stage IV cancer) from an analysis of several very large trials. A woman with a <1cm tumor has a 14% risk of metastases and 9% risk of death from breast cancer in 15 years, compared to 19% risk of metastases and 17% risk of death if the tumor is 2-5cm. This is for the most common types of breast cancer, and with all current treatment (surgery, radiation, chemotherapy). The reason this hasn't translated to a survival benefit for mammography is that most tumors are felt before they get to 2cm, and the differences in survival for <1cm vs. 1-2cm cancers are 4 vs 9%.

Overall, most cancer societies world-wide think that mammography every 2 years is sufficient. Probably more important than that is having any changes in your breast evaluated. Most of the women I have seen in clinic who have advanced cancer that is difficult to treat had something they felt but didn't get checked out for several months.

The important caveat to this is for anyone who has a parent with breast cancer. The risk of breast cancer is 2x (25% risk by 85 years old) for these women, and 1.5x (18% risk) if a grandmother had breast cancer. There is likely a benefit to mammography.

TLDR: women with a parent or grandparent with breast cancer probably will benefit for mammography. Otherwise, mammography won't reduce risk of dying from breast cancer but may reduce the risk of needing extra treatment down the road. 

Cassie

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Re: Ladies - mammograms
« Reply #104 on: May 23, 2019, 09:31:09 PM »
My mom ended up with stage one breast cancer at 78 but I blame the doctor who left her on hormones for 30 years. I donít consider myself at a higher risk.

sui generis

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Re: Ladies - mammograms
« Reply #105 on: May 23, 2019, 10:52:15 PM »
My breast tissue is dense, which apparently means I'm at higher risk and that it's harder to feel anything in manual exams. In fact, my previous OB/GYN told me they aren't recommending monthly manual exams anymore because it freaks too many people out an too many unneeded visits to the doctor. This AFTER I mentioned I had heard that If you do it enough you get to know the "normal" lumps in your breasts and are basically prepared to notice changes. And this was at the world class hospital system I mentioned I used to be a part of. So that really took me by surprise, but I was happy to be told not to do monthly self exams. I'd spent years trying them, never "getting to know" my breasts at all, and just feeling sick and worried after every single attempt.

It feels like what she told me may not actually be the current practice, but I'm still not going to start again, given the stress and uncertainty I experienced every time. I'm certain that, unless it was already advanced far enough for me to notice it just while washing up in the shower, I wouldn't know anything was wrong even if there was. My breasts basically just feel like a lot of variable lumps crammed together in a bag in the first place. It would take a lot for me to identify a new and unwanted lump making an appearance. But I see lots of references to monthly manual exams here! Am I the only one that could never get to know her lumps?

Pigeon

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Re: Ladies - mammograms
« Reply #106 on: May 24, 2019, 08:36:55 AM »
  I know a few people that mammogramís found their cancer early and they lived for many decades so I think itís worth it.

I'm one of those people.  I'd be dead if I hadn't had an early mammo.

Parizade

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Re: Ladies - mammograms
« Reply #107 on: May 24, 2019, 09:35:47 AM »
My breasts basically just feel like a lot of variable lumps crammed together in a bag in the first place. It would take a lot for me to identify a new and unwanted lump making an appearance. But I see lots of references to monthly manual exams here! Am I the only one that could never get to know her lumps?

Not the only one, I too gave up monthly exams for the same reasons. I don't have any family history so I just I get my eoy mammogram and don't worry about it.

pachnik

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Re: Ladies - mammograms
« Reply #108 on: May 24, 2019, 09:53:01 AM »
My breasts basically just feel like a lot of variable lumps crammed together in a bag in the first place. It would take a lot for me to identify a new and unwanted lump making an appearance. But I see lots of references to monthly manual exams here! Am I the only one that could never get to know her lumps?

Not the only one, I too gave up monthly exams for the same reasons. I don't have any family history so I just I get my eoy mammogram and don't worry about it.

It sounds like you and I have similar breast tissue.  IIRC, my previous doctor said mine were quite fibrous.  I somewhat know my lumpy stuff.  I do the monthly exam still though. 

I am in Canada and here mammograms are recommended every 2 years after the age of 50 so that's what I've been doing.  My doctor also does a manual exam once a year during my physical. 

BeanCounter

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Re: Ladies - mammograms
« Reply #109 on: May 24, 2019, 11:54:12 AM »
I am in Canada and here mammograms are recommended every 2 years after the age of 50 so that's what I've been doing.  My doctor also does a manual exam once a year during my physical.
This Canadian recommendation makes so much sense to me. I think the commercial fee for service medical system in the US has skewed our system.

brooklynmoney

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Re: Ladies - mammograms
« Reply #110 on: May 24, 2019, 06:25:54 PM »
Ugh Iím 6 months overdue on my false alarm follow up mammo so need to make an apt for June but for some reason Iíve been randomly spotting for weeks and still have 1 more month left on my 3 month pill pack so i feel like if I go now I will just be all hormonal and have a false alarm again.

NewPerspective

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Re: Ladies - mammograms
« Reply #111 on: May 26, 2019, 06:22:37 PM »
Hello!!!  I just had my yearly mammo and ultrasound too.  All clear but I was veeeery nervous. @sui generis I'm so glad everything was ok for you as well.

I have pretty much decided I'm going to do yearly screenings, including the ultrasound (I'm 42).  I'm too scared not to, although I was one of those that ended up getting a biopsy last year because of something the US picked up.  I have very dense breasts apparently and because this raises my risk I feel like yearly screening is prudent. I don't have other risk factors so I'm not clear how much this raises my risk exactly. I should probably go talk to a specialist about that (my regular doctor doesn't seem to really know). I have very mixed feelings about all of this because of the fact I think about it A LOT and it has a substantially negative impact on my life.

Dicey

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Re: Ladies - mammograms
« Reply #112 on: May 27, 2019, 08:19:51 AM »
[Snip]
I think Atul Gawandeís book Being Mortal should be mandatory reading for everyone. over 40
FTFY. Awesome book. I've read it twice and will probably do so again. Can't recommend it highly enough.

LifeHappens

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Re: Ladies - mammograms
« Reply #113 on: May 27, 2019, 08:24:42 AM »
I have very mixed feelings about all of this because of the fact I think about it A LOT and it has a substantially negative impact on my life.
Do you have a family history of breast cancer? Because to me this sounds like more of an anxiety issue than a health issue. There is no harm in talking with an oncologist and coming up with an evidence-based plan for screenings based on your personal risk factors, but you might also seek out some resources on managing anxiety.

partgypsy

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Re: Ladies - mammograms
« Reply #114 on: May 27, 2019, 09:55:19 AM »
I mull about this too what is the appropriate level of treatment, but for now I have good health insurance, so might as well take advantage of it. I've always had fibrocystic breast tissues. This last mammogram they saw something suspicious (microcalcifications) and I had a biopsy. They found ductal hyperplasia. not considered cancer, but makes me at higher risk for developing  I have the option of increasing my mammograms to every 6 months for the next 2 years, or get what's called an excisional biopsy to take out all the atypical cells. I'm going to go ahead and do the excisional biopsy. I don't have any breast cancer in my family, but I've been on oral contraceptives for the past 30 years and do have dense breasts. In retrospect, maybe should have switched to something else for bc. Im going to get off the oral bc in next year or 2.
« Last Edit: May 27, 2019, 04:56:59 PM by partgypsy »

NewPerspective

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Re: Ladies - mammograms
« Reply #115 on: May 27, 2019, 01:22:50 PM »
On a day like today, sunny, warm and calm,  I think I'm insane for worrying so much.  Most of family think I'm crazy - there is no history of breast cancer.  In fact my maternal grandmother and great grandmother both lived into their late 90's.   The paternal side is a little different (no breast cancer) but that is mostly life style related as far as I can tell. (Why yes, I did my entire family tree going back three generations just to see if anyone died of breast cancer. :-))

I've honestly considered getting a mastectomy because I think my dense breasts are just a ticking time bomb. (I do not have the BRCA gene).

Like some of the others that have commented I also have lumpy tissue.  I find it difficult to imagine that I would know if a new lump popped up. I've sent myself into hysterics over the years because I've felt something "different".  Come to find out it was a cyst that  has gotten larger or has shrunk.  My tissue feels very "grainy"so I'm not really sure how I would know if there was a cancer lump compared to an every day lump. Because of this I'm not great about doing monthly exams, it just freaks me out.

I've read On Being Mortal, I really enjoyed it but I didn't find it comforting really.  Maybe I should re-read?

@partgypsy birth control protects against certain types of cancer (Ovarian I think) so you have that working in your favor!

partgypsy

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Re: Ladies - mammograms
« Reply #116 on: May 27, 2019, 05:00:51 PM »
I have twice gone to the dr because of feeling lumps. Once in my 30's, doctor could feel it, got mamogram for it, nothing there. The other time the doctor could not even feel the lump and so if I got a mamogram I would have had to pay for it, so I didn't. The suspicious spot was in a different area!

One thing I do have to say, is weaning myself off caffeine (just having tea) has really helped with the "lumpiness" and also pms pain. So if you haven't tried that you should try that first. There are other risk factors namely being sedentary, eating high fat foods and also drinking alcohol that are associated with increased breast cancer. So if you want to "do" something those are things I would recommend : )

MoolahLula

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Re: Ladies - mammograms
« Reply #117 on: May 27, 2019, 06:57:40 PM »
This is a timely topic for me.  Iíve been having mammograms since 2013 and last week I had to go back for more images and now I have an appointment for a needle biopsy this Saturday.  I have 6 calcifications in my right breast that I did not have on my last mammogram.  I too have very dense breasts and a mother who had breast cancer.  Before I started getting 3D mammograms I went back for further ultrasounds every 6 months to keep tabs on an asymmetrical cell in my left breast, which I still have.  I do not have the BRCA gene according to 23 and Me, but right now Iíd sign up for a radical removal of my breasts and get new smaller ones.