Mammograms and other musings

While I should be working on slides for an upcoming presentation, I've been getting a lot of questions about how I feel about the new mammogram recommendations. I have to admit to being somewhat ambivalent. As someone who had gotten annual mammograms since 30 and yet they managed to miss my slow-growing tumor--even when it was explicitly pointed out to the radiologist--I have some sympathy for the people behind the study. I think having a fairly useless test isn't a good use of healthcare dollars.

Mammograms are a notoriously bad technology for finding tumors in younger women. Maybe this should be the main takeaway point. Most things that look dark or light are not tumors, and masses can be missed. If this leads to more nuanced discussions, that could be good and maybe skipping some mammograms isn't such a big deal. Of course, I would like them to replace them with alternate technology. Ideally, letting women for whom they find the technology doesn't work well have mri earliers could be a good thing. My take away is that we rely on tests that may or may not save lives. Thinking about the prevalence and effectiveness of these tests is a good thing to do. Partly, I feel a little bad about my prosletizing to friends who postponed getting mammograms in the past.

Of course, I had this conversation with a friend who found a small tumor, and she is beating herself up a little bit about the fact that she skipped a year and the tumor is bigger than it might have been. It's not clear that they would have found it anyway. Getting back to me (after all, it's all about me), this seems possible given that they managed to miss mine for a number of years.

Not sure whether some of the little tumors would disappear or not metastasize, but I do find the evidence compelling that some small tumors that have been found probably wouldn't have grown into malignant tumors. We'll see how it all pans out, and it seems from the backlash that the report might not change recommendations.

So I'm less exercised than others about the rulings and find it slightly self-serving that radiologists seem to be the folks most adamant about the new recommendations being bad. (Nothing to do with the money they will lose.) I hope people will take the tests not to be magic bullets, be in touch with their own body (both literally and figuratively), and be their own advocates if they think something is wrong and figure out what the right response to their situation should be.

I keep coming back to the fact that I had a lump I was nervous about and let it go for 6 months after getting a mammogram the first time around, and did not insist on having a biopsy. As with all things, I'm trying to let go of the regrets for indecisions past. But I was pretty sure something was off but was happy to live in a state of denial for a little while which in the end has lengthened this whole process.

In other news, last week's illness ended up not being H1N1. I found out on Friday at 3pm that it wasn't flu and maybe didn't need to be under quarantine. However, it certainly must have been some virus as the tamiflu was a miracle drug. My brother's surgery also went well. He seems to be on the mend and sees better out of the eye already.

I spent Wednesday having some other standard doctor's appointments (I needed pre-surgery cardio-clearance). My heart seems fine, though I need an echo, and I had my gyno exam. On the plus side, the new cervical cancer rules make me feel less bad that I went about 2years without a pap smear. Somehow, earlier this year I couldn't add other routine appointments back into my life, as I had hit my doctors' appointment wall. The upside of going to a women's health center was that I was able to get the H1N1 dead vaccine (the flu shot not nasal spray) because the women's center had it in stock for pregnant women and they were willing to give it to me. Apparently, being high risk all on my own was enough to qualify and to report back to the health deparment.

So I am hopeful I will be swine flu free as I recover from surgery. (Yes, my nightmare scenario was coughing and sneezing after abdominal surgery.) Now I need to stop focusing on my health and go back to the craziness which is the states' fiscal health. CA has a $20 billion gap developing already.

Oh joy. Hope you all have a Happy Thanksgiving and stay healthy even with the hordes of travelling folks.