Mammograms

Northwestern Memorial Hospital in Chicago recently sent out a letter to its patients. Wait, can I anthropomorphize a hospital? I guess I can. Let me start over.

Northwestern Memorial Hospital recently sent out a letter to its patients informing them that because of a shortage of radiologists, women should make appointments for their mammograms ten months in advance.

I talked with Rich, a radiologist acquaintance, about this practice and he explained it to me. Reading a mammogram is fraught with difficulty. First, if there is no previous mammogram to compare it with, it is hard to tell if there are problems. Additionally, they are difficult to read and only well experienced radiologists are truly competent to read them. That means the radiologist ought to have read thousands in the past to truly understand what s/he is reading. Finally, if there is a misreading, the liability to the radiologist and his/her insurance company is great. Few radiologists want to read mammograms, and the ones who do make a living at it are flooded with them.

Doctor shopping is a cause of this problem. If a patient goes from one doctor to another, no previous, baseline mammogram exists, and the possibility of an error in the reading increases.

Denial, of course, is another huge problem, and it isn't confined to the people in my generation or older. No woman wants to lose her femininity. The way breasts are portrayed in movies, on television, in print media, and in 'fashion' objectifies them as sexual toys. This increases the fear of losing one.

Rich said that women should get their first mammogram at about age 35 to establish a baseline.

I think - this is my suggestion because he did not mention it although he may agree - once they have that baseline, they should get a copy of the X-ray so if they move, the doctor has a basis of comparison. And it probably wouldn't hurt to get copies of every mammogram just in case they change doctors or on the off chance that the originals are misplaced, damaged, destroyed or lost. I can't imagine that thousands of films every year are all safely stowed.

My mother-in-law died in hospice of breast cancer that metastasized, eventually to her brain. It was not pretty, and the main reason, I believe, is that she played Cleopatra, Queen of Denial. She refused to believe she had a lump, and rationalized it as a bruise from falling. She refused to believe her breast should have been removed after the first mastectomy and called the doctor a butcher. Her scar was not neat, and I don't believe her surgeon treated her with respect because of her age and gender. (Why would he be a surgeon if he felt that way? The money, of course.)

After her first mastectomy, she refused to believe, once again, that the huge lump in the lymph node under her arm was a portent of further cancer. She did not see a doctor until the lump became so big she could not put her arm down at her side. By then the cancer had spread, and it continued to spread, albeit slowly because of her advanced age.

The moral of this story is that all women should get baseline mammograms at age 35 and annually after the age of 40. And they should check for lumps monthly.

Finally, a piece of arcane knowledge: Mammograms are so distinct they can be used forensically, like fingerprints or dental records, although it isn't glamorous so the crime scene television shows haven't used this method of identification yet.

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