2/01/2005

The C Word

Ivan Noble died yesterday, at the age of 37. This was the writer who kept the BBC online tumor diary (or tumour, because he was British). I only read it once or twice, because I'm Jewish and, thus, much too scared of cancer even to read an inspiring, brave and honest diary on the subject.

He died yesterday, and today I decided not to get a mammogram. Those two things have nothing to do with one another, but they strike me, sitting here at my computer, as interesting nonetheless. I'm not a scientist, God knows, only a hypochondriac, and I am thus not qualified to evaluate the mountains of data on mammograms, pro and con. I know I'll get one when I'm fifty. I know the recommendation is to have one every other year at forty. I'm just not sure it makes any sense to do so. Let's say the mammogram actually finds DCIS (Ductal Carcinoma In Situ). I have four children, so I'm going to treat the hell out of that son of a bitch. I'm going to slash and burn, despite the evidence indicating that only 30% of DCIS cases go on to develop into cancer. As a mother, how could I risk being in that 30%? The chances are good that I would end up traumatizing my body and my mind for no very good reason but I would feel like I had no other option but to make that choice.

I would likely make a very different decision about the mammogram if I had cancer in my family. As far as I know, none of my female relatives have ever had cancer, other than my Auntie Helen, a smoker, who died of lung cancer. I have the luxury of batting around probabilities and statistics. So far I've been very lucky. Ask me next year, at my annual appointment, and I may have another opinion entirely.

614 Comments:

Anonymous Anonymous said...

I have gone to get mammograms begrudingly for the past two years because I turned forty and my OB/GYN said I should. *sigh* Since my last mammogram I've had two friends find out they had breast cancer and that's how they found it. It's made me realize (along with a few other friends getting sick for various reasons) that I'm at the age now where I'm going to start to hear about this more and more and I better deal with it better than I have been... which has been the "complete freak-out mode".

February 3, 2005 at 2:01 PM  
Anonymous Anonymous said...

I don't know, Ayelet. Do you really think that if something showed up on a mammogram that you'd be unable to make a measured and appropriate decision about how to treat it?

My mom is alive today (75 last month!) only because of early detection on a routine mammogram -- a mere shadow on the film, picked up by a competent radiologist -- but six months or a year later, and it would have almost certainly been too late. While she WAS over fifty at the time, she had no family history.

So I'm all for following the screening guidelines religiously, indignity, discomfort, and anxiety be damned. I tend to be a bit counterphobic, though, so maybe that's it...

February 3, 2005 at 2:46 PM  
Blogger Formerly Mrs. Kennedy said...

Wow, you Anonymouses are so rational. I'm 41 and I've never had one, either. Some natural health article I once read suggested that mammograms cause breast cancer and I've been burdened by that suspicion ever since. My mom had the early detection catch one at 65 and now she's 80 and etc. Oy.

February 3, 2005 at 3:01 PM  
Anonymous Anonymous said...

I follow the rules. Baseline mammo at 35. Yearly mammo's after 40. I'd feel too much anxiety if I didn't. I schedule my annual gyno appt for 6 months later so I get "the girls" checked biannually. Don't think about it. Just do it.

February 3, 2005 at 3:19 PM  
Anonymous Anonymous said...

I had a friend whose breast cancer was detected when she went in for her baseline mammogram at 35. As far as I know, she had no family history, either. Fortunately, it was detected early and she's fine. But when my doctor suggested that I get a baseline mammogram when I turned 35, I went in and got one. And when I turned 40, I got another one, and every year since then. Yeah, it can be a tough call to make about what to do if they find something, but not looking ain't going to make it go away.

February 3, 2005 at 4:12 PM  
Blogger hi said...

Ayelet,

I have to admit I feel like that one uncomfortable guy at the women's luncheon table, talking about this mammogram business (do what you do, man, just, you know, go on and like, do that thing, or whatever - not that I don't care - I do - just a little out of my element here); but can I just say thank you for finally posting. At least once a day at work I load your blog and hope you've put up something new, and now you have, so I only have to wash my hands 15 times, instead of the now-usual 24.

Just kidding. Actually, I never wash my hands.

Actually, that's not true. I wash them sometimes.

After I pee, mostly, or before cooking.

Um, sorry.

Günter

February 3, 2005 at 4:22 PM  
Blogger Lynne said...

Gosh, it's so freeing to know that I live 2000 miles away from you, Ayelet, and thus can be perfectly honest! I'm kidding around, but it does sound as if you, being the intelligent and verbally-talented person that you are, are doing a great job of talking yourself OUT of something that is just not that big a deal.

I'm 50 and have had three mammograms so far. The first one, I'm standing there, with my breast sticking into the machine as they do, trying to be nonchalant. The technician asked me what I do for a living, and I told her I'm the assistant to the editor at our local newspaper here in Bloomington, Indiana. So, there I am trapped with my breast in there, and she starts complaining about her newspaper delivery! (Our Circulation manager just loved that story.) I cheerily said "Not my department!" That memory makes me laugh whenever I go have a mammogram now!

I think the biggest mistake moms make is not taking care of themselves -- and that is so universal.

Now, every day, I occasionally check my email, my bank account, the website for my friend's hospitalized baby, and then for fun check to see if something is new on your blog!

February 3, 2005 at 6:26 PM  
Blogger Anshel's Wife said...

I have a rabbi friend who says you aren't sick until you are diagnosed. Which means, don't take the tests, of course.

But my mother just had a colonscopy which found a malignant tumor. She had surgery about 2 weeks ago and thank G-d, is fine. If she had had the colonoscopy a couple of years earlier, the tumor would have been a polyp that the doctor would have snipped out during the first procedure instead of having to go through the physical and emotional trauma of having cancer.

As a Jewish mother, also of 4 children, I'm telling you to go do the right thing.

February 3, 2005 at 6:50 PM  
Blogger 21st Century Mom said...

I had my first mammogram at 49. Women in my family don't get breast cancer until they are in their 70s. That's a great rationalization, don't you think? And then there is the guy who wrote a whole book about how too many mammograms is part of the reason breast cancer is on the rise. I embraced that postion with great zeal, never having read the book.

So far, so good but having lost my mother to cancer (breast, throat, neck) I think I'll get on the schedule. Oh wait - they just changed the schedule at Kaiser to once every other year until you are 60. See, if you wait long enough you hardly ever have to go get a mammogram and that's just the way we like it.

February 3, 2005 at 10:57 PM  
Blogger nita said...

I had a breast reduction and I kept having dreams that when they opened me up I was full of black, squirmy gunk...

My mom had an antique shop when I was growing up and those deguerretypes were freaky even when the people were alive!

Love you blog and your books look great :)

February 4, 2005 at 6:27 AM  
Blogger Ang said...

I am enjoying your writings so MUCH!!! You are such a good writer!
(I just registered for Blogger just to be able to comment.)

I skipped getting a mammogram for six years. I was breast feeding and the doctors would tell me to stop just so I could get a mammogram and they wanted to put me on tamoxifen. Yet, conversley, a study in China showed that prolonged breast feeding lowers your chances of breast cancer.

Most of my female realtives have had cancer; my sister was diagnosed with breast cancer at age 35 and died when she was 40, my paternal grandmother of ovarian at 47, my mother and my maternal aunt both have breast cancer post menopausal. : sigh:

There was a NYTimes article that if you were to autopsy ALL men you would find prostrate cancer. But it didn't kill them.

You could get a sonnogram or a color MRI... but the chance of discomfort doesn't sound to be the reason for your hesitation.

You go for what you want girl!

February 4, 2005 at 10:25 AM  
Blogger MB said...

I have two grandparent who died from colon cancer. That puts me at something like a 5% risk, way above the nation average. So, this Christmas, when I have this 10 day intestinal "thang" which included lots of blood (sorry, I know, TMI), do I rush myself into the ER for an immediate colonoscopy? Nah, I call my PCP, arrange an appointment, and then cancel when the intestinal thang, blood and all, goes away. Out of sight, out of mind, neh?

I'm the same way with my obvious development of MS. Three docs and my opthamologist (sp?) have told me they're 99% sure I've got it, but I keep putting off the MRI which would most likely diagnose it "fer sure". Heck, if Jeb Barlett has problems as President with MS, what if I ever want to run for public office...oh, other than state rep in little insignificant old Maine.

February 4, 2005 at 3:52 PM  
Blogger Daisy said...

Well, here's something from the good news department: those kids of yours may actually be good for you. According to some cancer researchers I know, the biggest correlative for reduced risk of breast cancer is number of children and age when you have them. That is, the more kids you have, and the earlier you have them, the lower your risk. No real idea how it works, maybe it's just Mama Nature's idea of payback.
Not that I'm trying to discourage preventive medicine, just thought you'd like to know.

February 7, 2005 at 10:26 PM  
Anonymous Anonymous said...

My friend died last year she battled it for 3 years and died at age 38. It did not run in her family at all. Her son was 15 years old when she died.

I don't understand your reluctance. Go get one. Sure it's uncomfortable but it's the most accessible form of detection right now. "As a mother, how could I risk being in that 30%?" As a mother how can you not want to use the technology available to you to possibly ensure you are around to raise your children? EARLY DETECTION IS KEY TO SURVIVING. It's only an hour out of your life and for 1/2 of it you get to read a People magazine for crapsake!

If they find something educate yourself before making decisions. This story is over 10 years old but still very relevant. and inspiring. http://seattletimes.nwsource.com/pacificnw/mollyscancer/

February 8, 2005 at 5:28 PM  
Anonymous Phebe Hanson said...

Ayelete, this is a fan letter rather than a comment.
My daughter and I were in the audience when
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February 23, 2005 at 2:51 PM  
Anonymous Anonymous said...

i'm surprised how judgmental the comments are about mammograms -- there is a lot of controversy about this issue and i've known alot of women who have had very unpleasant bioposy experiences, and for pre-menopausal women, it's not clear that mammograms are that useful, not to mention that your cumulative dose of radiation is another cancer risk factor. So do what you feel is right for you not "the right thing" as prorposed by someone else.

March 14, 2005 at 11:16 AM  
Anonymous claire said...

Ayelet, I have many medical problems, among them one which has forced me to get yearly colonoscopies for a long time. Now THAT's an inconvenience.

A mammogram is really nothing in the scheme of things! It's barely painful, there's no preparation, and the results (at our tender age) are likely to be good or at least EARLY.

My mother and grandmother both had DCIS and both have lived at least 20 years past treatment... B/C is so curable, and so common, I urge you to just go ahead and have your mammo over on Telegraph, and forget about it!

BTW in the last 2 years to 49-50-year-old close friends of mine were diagnosed and treated for B/C, one DCIS, the other slightly worse. And, another friend, age 52, died of B/C. All in 2 years. It's THAT common - so get your mammo.

March 14, 2005 at 4:37 PM  
Anonymous Shamhat said...

I completely agree with your reasons for not getting a mammo. All of the thrilled "cancer survivors" due to "early detection" have no way of knowing whether they had unnecessary treatment for a "cancer" that would never have bothered them if they had left it alone.

It's much easier to just decline a test with a high false positive rate than to deal with an ambiguous "positive."

March 18, 2005 at 1:58 PM  
Anonymous Anonymous said...

I'm with you, Ayelet. The fear-mongering that goes on these days about cancer leaves it impossible to imagine that we aren't all doomed, as doomed as doomed can be, to end up bald and nauseous. I tend to think the whole thing has a lot to do with how disease research gets funded: people have to believe that they or their immediate family are at risk. This was done, to universal detriment in my opinion, with AIDS.

April 13, 2005 at 5:03 PM  
Anonymous Anonymous said...

I agree with you Ayelet. Unless you have a high risk factor, the evidence seems to show that its a reasonable decision not to have a mammogram before 50. You can't avoid the fact that yearly screening tests are a huge money maker for the medical profession and that many women are going through painful and traumatic false positives and biopsies, not to mention having unnecessary radiation.

April 22, 2005 at 7:11 AM  
Anonymous Anonymous said...

PLEASE get a mammogram. I had lymphoma at 43 w/o symptoms and have been alive 12 years now. When I asked my Dr. about mammograms he said his wife would get one every year no matter her age. why not take advantage of modern medicine and make certain your children have you forever??

April 27, 2005 at 3:01 PM  
Anonymous maryオナニー said...

I usually schedule my annual gyno appt so I get "the girls" checked biannually. Don't worry.
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