Your own breast friend
When I was in eighth grade, health was one of the few classes that consistently held my attention. During the cancer unit, not realizing that breasts are inherently lumpy, I began to harbor secret but intense fears that breast cancer was growing rampant inside of me. This was well before Google, and I had nowhere to go to research and allay my fears. Since then, while my knowledge of breast anatomy has become more sophisticated, my relationship to my breasts has grown no less complicated.
My mom was diagnosed with breast cancer almost 15 years ago. When I accompanied her to one of her appointments with her surgeon, he told me I should get a baseline mammogram sometime within the next few years. I was 29 at the time and while I hold a master’s in anxiety with a minor in hypochondria, I wasn’t worried for myself but rather my mom and seeing her through her lumpectomy and subsequent radiation. She came through it all OK and I’m happy to say she’s cancer free today.
As for me, I got that first mammogram when I was 35. While mammograms aren’t great fun, I didn’t think much about them and simply performed my annual duty as someone with a little higher risk. That changed when I was 40 and doing a perfunctory self-breast exam in the shower one morning when I came upon an unfamiliar lump in my left breast. My heart pounded and I began to panic. I asked my husband for a second opinion, hoping he would say he thought it was nothing. He did not. I got in with my OB-GYN’s office later that day. The nurse practitioner assured me that it didn’t feel like a cancerous mass. We could schedule a diagnostic mammogram, but I was due for one in a few months anyway. It was enough to allay my fears.
When the day of my mammogram arrived, I was not surprised to be called back for a follow-up ultrasound. Expressing my fears to my co-worker, she told me about her own experience with a breast lump, which turned out to be a cyst. I walked into the ultrasound feeling not terribly nervous and waiting to hear confirmation that the lump I’d felt was a cyst. It was not a fluid-filled cyst but rather something solid and I would need a biopsy. Would I like to do it now? I was not prepared for this and everything was moving too fast. At the same time, I most certainly did not want to delay the biopsy and finding out my fate. It all proceeded in surreal fashion and I went home and sat zombie-like as I awaited the results, most assuredly stage 4 metastatic breast cancer, I’d convinced myself. Mercifully, the results came back in less than 24 hours and the lump turned out to be a fibroadenoma, a noncancerous tumor.
I felt flooded with relief at the reassuring results, but my OB-GYN still recommended I see a breast specialist, who ordered a follow-up ultrasound some months later. The fibroadenoma was getting bigger and while not cancerous, the surgeon recommended I have it removed, as “we don’t like to have things growing in the breast.” No, I agreed, we do not. I had the surgery two and a half years ago and it was not a big deal. The fibroadenoma put me at only a slightly elevated risk for future cancer. My mom’s cancer diagnosis put me at greater risk, the surgeon said.
Unfortunately, health care issues are a continuum, not opened and closed. All my mammograms come with the same disclaimer, that I have extremely dense tissue that lowers the sensitivity of mammography, and that with “radiodense breast tissue” like mine, mammography misses 10 to 15 percent of breast cancers. And what’s a woman supposed to do with that information?
Dense breast tissue, even its very name, was confusing to me before I knew I had it. When I pictured dense breasts, they were what other, more amply chested women had. They weren’t the tiny, deflated-from-years-of-breastfeeding mounds that sat atop my chest. But that’s just what dense breast tissue is, and furthermore women with dense tissue have a higher risk of developing breast cancer. And yet to this day, figuring out exactly what that means for me isn’t easy. My doctor last year mentioned in passing the idea of doing a breast MRI but stopped short of recommending it.
This year, when I went for my mammogram, the tech asked me whether anyone had ever recommended an MRI to me. She works with the high-risk specialist at the breast center and “when she sees women who look like you,” with a family history, she recommends an MRI, she told me. I received the usual mammogram results with the same disclaimer. While I desperately did not want to have an MRI, ignoring the advice felt foolish and perilous. Reluctantly, I messaged my doctor about it. She agreed doing so made sense and after filling out a risk assessment and paying my exorbitant share of the price tag, my MRI was scheduled.
The day arrived this week. In the lead-up, I was filled with dread, as much about the MRI experience (I’d never had one) as the results that would follow. I’m not one to suffer unnecessarily, so I filled the Xanax prescription that was offered to me and reported for the test. When I entered the room, I suppressed my impulse to assess the size of the machine I would go into and my size relative to it. Instead, I kept my eyes shut tight throughout the test and repeatedly intoned the words “I am safe” in my head as the machine did its work and rattled noisily for about 20 minutes. It was not as bad as I had feared and I had hoped the worst of it was over. A stunning couple of hours later, I learned it was not. The test had found a 4 mm nodule on my left breast, and the radiologist recommended another ultrasound and possible biopsy.
Wednesday, I found myself, roughly three years after my previous ultrasound and biopsy, in the same spot. I didn’t want to be there and yet I wasn’t as scared this time or even really surprised when the ultrasound led to the biopsy. It was a long and tough week and the results took longer to get this time, which rocked me. They came last night, and the biopsy was negative. The news was a relief, followed by a call today that I’ll need to have a follow-up ultrasound in six months and another MRI in a year, and maybe another visit with the breast specialist. I’m gradually resigning myself to the fact that this is something I’m going to have to co-exist with. While it’s not fun, I need to keep doing what I need to do.
So, this was a long story to get to my final point. My doctors are awesome and amazing and yet I still had to be my own advocate for my health and ask for what I needed. Women’s health care needs work. I hope you will forgive me an unforgivable pun, but until it gets to where it needs to be we, as women, need to be our own breast friend — or bosom friend if you prefer an “Anne of Green Gables” reference.
The tests I’ve had have ranged from scary to physically painful to emotionally difficult to endure, but they have all been worth it. I want to do everything I can to ensure that I am here for my sons for many years to come. Nothing, including fear about what I might learn from some tests, should come in the way of that.
I’m not saying you should lobby for tests that you don’t need or ask for a breast MRI. Most people don’t need one. But know your risks. Do self breast exams and know what your breasts feels like and what your normal is. Take care of yourself, advocate for yourself and be your own breast friend.
