November 17, 2009
Tuesday

Unlike many Americans, particularly women who do not have a paying job, I am fully, and generously, insured, thanks to having worked for many years for a single employer. Benefits were part of the contract negotiated for me and my colleagues by a group that styled itself as a “professional organization” because “labor union” sounded so blue-collar and so adversarial, but that’s what it was. And in order to express why these benefits continue for me, I will have to use the “R” word that I avoid. As a retiree, I continue to have my health care expenses covered to the same degree I enjoyed as an active employee.

October and November have become the months when I get all my systems reviewed. Most general exams and routine tests are covered once in a calendar year, and you always have to be sure to schedule the next year’s for after the date of the previous year’s. I used to have these things done in the summer. “Calendar creep” means that these days I get poked and prodded and punctured in the fall.

So I arrived at my convenient neighborhood imaging center for my annual bilateral screening mammogram a scant twenty-four hours after the new guidelines were announced by the U.S. Preventive Services Task Force. Routine screening is no longer recommended for women ages 40 to 49, and women 50 to 74 should be screened every two years, not every year.

I, of course, was there for my fourth mammogram since last year. As my habitual readers might remember, I had something of an odyssey last year when my routine mammogram showed an increase in small calcifications that appeared to be clustering, as if they might be gathering for an attack. (I’m a poet, not a scientist.) I had a stereotactic needle biopsy that showed the condition to be benign. A second mammogram was performed at the time of that procedure to record the placement of the markers that had been left to indicate where the tissue had been taken, and a third was performed in May as a followup. I was told to come again in November, to get back on that annual track.

Despite the generous insurance noted above, and despite my diligence in scheduling Lynn’s well baby visits and immunizations, I can be neglectful of my own routine studies, particularly when I have to go to a different provider at a different location at a time different from my annual physical. There is no breast cancer in my family that I am aware of, and I have few other risk factors. So I didn’t have my first mammogram until I was 45.

Mammograms are interpreted while you wait. You have the procedure, and then you take the foam pad that’s been used for you and sit, still in the cotton gown that opens in the front and is always either too big or too small, in an inner waiting room. After a short while, the radiologist who has read your films takes you into a private examination room and tells you what he or she saw. Last year there were four sets of pictures and a radiologist who wasn’t taking any chances on deciding what those shadowy particles he saw were, and recommended the more invasive procedure.

I don’t know what motivated me to go for that first mammogram in 1992. Maybe I was at one of many crossroads in my life. Lynn was starting first grade and I was starting a new graduate degree, and I knew I had a lot of living to do. I remember that the radiologist seemed puzzled. “Why did you come for this test?” he asked me. He said the films were absolutely normal and he couldn’t find anything to comment on. “Are you having problems?” Well, no, I wasn’t, but I thought I was five years late on getting a baseline reading. I left wondering if I should have had the test, if maybe I was taking advantage of a benefit simply because I could.

The new guidelines have confused some people, alarmed and angered some others. Viewed as a matter of cost vs. benefit, the pronouncement can seem cold and impersonal. I heard Dr. Nancy Snyderman say that of 1900 women under 50 who are screened, only one woman’s life will be saved.

I know that one woman.

Jody Bailey, a woman in her late forties whom I know online from a discussion list peopled by editors and writers and other wordsy types, was diagnosed with invasive ductal cancer in August and underwent a mastectomy. She blogs about it at The Fourth Sign. It’s an honest and gutsy effort to document her experience. She acknowledges that although the new guidelines do not prevent women from having mammograms in their forties, they do discourage them if no other risk factors are present, and ultimately (I think) this will lead to reduced insurance coverage for early mammography. Jody says that if she had waited until she was 50 to begin mammography, she wouldn’t have gotten there. Her cancer, undetected early, would have grown unchecked, and killed her.

CNN has reported that Dr. Otis Brawley, chief medical officer for the American Cancer Society, says “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

I am in the age group where screening is now recommended every two years instead of every year. My recent history dictates that I should have one every year, and my insurance will undoubtedly continue to cover it. Even if it didn’t, I am in a position to be able to pay for the test myself. I understand the science, both biological and mathematical, that arrived at the new recommendations. But I also understand that statistics aren’t people. My daughter, a scientist whose paternal great-aunt did develop breast cancer, is sixteen years away from her first mammogram under the old guidelines. I don’t know what the landscape of testing and treatment will be when she gets there. In the meantime, I will encourage her to proceed with monthly self-exams and to remind her that the loss of her, to us who know and love her now and to the children she will surely have by then, would be a tragedy.

My study today showed nothing unchanged from May. My mind is at ease about that, at least, allowing me to think good thoughts about the questions to be asked and answered next month.

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The NaBlos of the Past:

2008: I did not post on this day in 2008, because I was too distracted by 2008’s health crisis.

2007: Taken by the Sky — For many years I’ve given my Gallivants titles, like rock groups’ concert tours. I called my 2005 sojourn in Wyoming Taken by the Wind. Today I found the title for this magical time out west. Rhiannon is the Welsh goddess of change and movement. Accompanied by three birds that symbolize strength, sexuality, and the overcoming of doubt, she comforts those in crisis and restores laughter to those who mourn. She is Taken by the Sky.

2006: I did not post on this day in 2006.

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