Tuesday, October 29, 2013

(s)mashing pumpkins: why I am done with mammograms

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"An ounce of prevention is worth a pound of cure." - Ben Franklin
I plan never to have another routine mammogram. Ever.

I'm not a big risk taker. I don't take drugs or wear fur to PETA meetings or talk about politics on Facebook. I don't jump out of planes or snowboard down mountains or swim with sharks. I don't even like to swim in water over my head.

So why would I ignore convention and refuse to have an annual mammogram to screen for breast cancer?

Artwork (ha!) property of Cindi Carver-Futch. Do not use without permission.

Don't I care about my family or my health or my future? Everyone knows mammograms save lives. Every woman is supposed to have a mammogram every year. The more mammograms, the better. Right?

Well, not so fast. While this has become the popular and readily-accepted message, there is some controversy surrounding routine mammograms. Some studies suggest that screening mammograms are not likely to catch cancers at an earlier stage when they are more treatable. There is even some evidence that the radiation used in screening mammograms can contribute to cell mutation leading to the development of cancer in later years.

Now I am not a doctor, nurse or any other kind of medical practitioner. I did not spend last night in a Holiday Inn Express. I am not making medical recommendations. But I am a woman with two breasts, a brain, and the ability to reason, meaning I am capable of using experience and research to make decisions for myself. And as a writer, my experiences and opinions are my stock-in-trade. So I am sharing my experience, for what its worth.

I have had mammograms. Plenty of them. I had my first mammogram in my mid-30s, far earlier than normal. I was about to go through fertility treatment, so my OB/GYN advised getting a baseline mammogram before we started the first round of hormones. Fine, I thought, we'll just get this over with and move on. 

Turned out it wasn't quite that simple. I have very dense breasts, which make reading results of mammography nebulous at best. I also tend to have benign lumps. These show up on mammograms and ultrasound, but since they are difficult to see in my dense breasts, I have endured multiple breast biopsies and lumpectomies. (Read about my experience here.) 

During my last mammogram, the doctor recommended inserting a titanium clip on the most recently discovered lump so it could be easily identified during my next mammogram. 

But the "next" mammogram never occurred.

A few years ago, after much reading and research and discussion with my doctor, I started having breast thermograms instead of annual mammograms. 

So, what is breast thermography?  According to Allan D. Lieberman, MD, medical director of the Center for Occupational & Environmental Medicine (COEM) and founder of the Center for Women’s Health:

"Breast Thermography, also known as Digital Infrared Thermal Imaging or Medical Thermal Imaging, is a screening tool for early breast cancer detection. It uses ultra sensitive infrared cameras and sophisticated computer software to identify unusual changes in the temperature and blood vessels of the breasts. 
Breast Thermography is based on the principle that a cancer requires an infrastructure of abnormal blood vessels to supply the nutrients necessary for cancer’s growth. These abnormal blood vessels are not under the control of the Autonomic Nervous System (ANS) and do not constrict in response to cold, whereas normal blood vessels supplying healthy tissues do. The Thermogram is able to visualize this infrastructure of abnormal blood vessels, even when the cancer has only progressed to the size of a small pinhead, by detecting the increased heat and blood flow surrounding abnormal tissues. 
This phenomenon is what increases clinical Thermography’s sensitivity (accuracy) and specificity (ability to rule out false positives). Mammography, in contrast, has a high rate of false positives necessitating further invasive testing."
What is the first thing we do when we think a loved one might be getting sick? We feel their forehead or take their temperature. Body temperature is a prime indicator of health status. Doesn't it seem logical that the same indicator, obtained using a noninvasive, pain-free, and radiation-free process, could be used to screen for and monitor breast health?

In an article published by Thomas Hudson, MD, a physician, radiologist, and former director of the Women's Imaging at the Naples (FL) Diagnostic Imaging Center, he states:  

"Thermography ...has some advantages that a mammogram doesn’t, including the ability to detect physiologic changes in a cancer while it’s still in the cellular phase—sometimes years before it is detectable mammographically. 
Thermography can also detect lymphatic congestion and hormonal imbalances as well as monitor dietary changes. It can assess breast cancer risk, which is also something mammography cannot do. In short, thermography is a tool to monitor breast health, not just a way to find disease. And there is no radiation or breast compression involved. It’s not a replacement for mammography because mammography has some important advantages that thermography doesn’t, but it’s a useful adjunct.  
Thermography, with its ability to assess risk and monitor breast health, leads to perhaps the most important point that’s never mentioned in this debate, which is that breast cancer risk is largely modifiable. Only 25% (and probably less) of breast cancer cases have any genetic component, which means that 75% of risk has to do with other factors; diet, stress, and environmental factors being among the most important."
I scheduled my breast thermography in time to take advantage of the October breast health discount. My insurance will not pay for it up front. They might reimburse me if I bother to submit the coding sheet and receipt. Either way, I am glad I have the freedom to choose, and see the $125 out-of-pocket expense as an investment in my health.

Please note: I am not anti-mammography. If my breast thermogram ever turns up anything suspicious, mammography will be the next logical step. It is still a valuable tool in identifying and diagnosing breast cancer. However, it is not the ONLY tool  - and may not always be the best tool - for routine screenings. And it does nothing to detect the status of or assist with improving breast health. 

I want to be proactive in doing whatever I can to keep my breasts healthy and having a method I trust to monitor how well I am doing. For now. I choose the option that doesn't include smashing, radiation, false positive diagnosis, or dread. 

Sounds like a lot more than an ounce of prevention to me.

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