Opening ‘Pandora’s Box’ and getting my first mammogram
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Last year, I had the chance to do something I’d only ever heard about — a lot about — but had never experienced myself.
It involved a towering, whirring machine, dimmed lighting and someone yanking on my pec muscles.
That's right: I got my very first mammogram.
A lot of people find mammograms intimidating and awkward — physically, or even to talk about in the first place.
Like, here’s my mom Deb Jarecki’s poetic way of describing them:
“It’s uncomfortable. … It’s like somebody puts you on a cement garage floor and backs a car over you!”
And health care organizations offer so much varying guidance about mammography, which can make it hard to figure out if someone should start getting screened — and when.
Providers say that’s a problem, because mammograms are an essential tool to catch breast cancer before it advances too far to treat.
So, I’m sharing the experience of my first mammogram in the hope of demystifying this procedure for anyone considering a breast cancer screening.
And a heads up, I’m using the term “breast” in this story, but chest health is also common, since people of all genders are at risk for breast cancer.
It was an almost-hot September day when I drove to Porter Medical Center in Middlebury with Vermont Public reporter Elodie Reed, who was there to both document the procedure and provide support.
When she asked how I was feeling about the appointment, I confessed that I'd woken up pretty anxious that morning.
"So much of it was having that more 'host head' on and then I woke up this morning like, ‘Oh, but you’re, like, the human being getting a mammogram today, these are your breasts and this is your breast tissue. … It’s actually happening,'” I told her.
Clearly, this was no regular doctor’s visit. But let’s rewind for a hot second, because those nerves definitely preceded my appointment.
My mother always told me: you turn 40, you start getting routine mammograms, but when 40 came around, I wasn’t quite sure. And here’s partly why: 15 years ago, a major national group that influences doctors and insurance coverage changed course to recommend no longer starting routine screenings at age 40, but 50 instead.
Meanwhile, there’s an alphabet soup of acronymed health care organizations with their own mammogram guidance. So I thought I'd ask my primary care doc Catherine Naden what she thinks.
“How worried are you that you might have breast cancer? How much do you want to open Pandora's box? Sometimes people have less anxiety keeping Pandora’s box closed, and sometimes they have more anxiety knowing that they’re choosing not to open it,” she said.
For me, keeping that box closed wasn’t an option, so I requested a screening.
Breast cancer is fairly common in middle age. Dr. Naden says it can occur earlier in life than many other cancers.
“You don’t expect to get cancer at 40," Naden says. "It’s the first time for most people that they have to face their mortality, that they might actually get a cancer diagnosis out of this test.”
And if there's one thing I consistently heard from Dr. Naden, and pretty much everyone else I spoke to for this story, it’s this:
“Breast cancer is very treatable if we can catch it early."
"The more screening we do, the more cases we detect, the earlier we detect them and the more treatable they are."
"Early detection is so, so critical."
"Absolutely, early detection is the best!”
A mammogram is an X-ray of your breast tissue, and the screening, start to finish, usually takes about 10 minutes. Your very first set of images are crucial since they establish your baseline. These baseline images are what your future mammograms are compared to.
And mammography is all about comparison, because it helps with, you guessed it: early detection.
Early detection can be paramount in finding breast cancer, particularly for aggressive cancers, which is why experts are worried that at-risk Americans are getting far fewer mammograms than they did 15 years ago when popular guidance shifted. According to UVM Cancer Center research from last spring, Vermont has seen the second steepest decline in screening rates of any state in the country.
But knowing if you’re at risk — and if it’s the right time for a screening — can be tricky. Dr. Naden recommends talking to a provider you trust.
“This is a very nuanced conversation," Naden says. "It’s really got to be about family history, when you had your first period, how many kids you’ve had, and it’s not really something that can be boiled down to a soundbite of, ‘This is who is average risk,’ and, ‘This is who is high risk.’”
But sometimes — be it the physical discomfort of the exam, the potential results, or the way someone is raised — people can be apprehensive about getting mammograms. That brings us back to the drive to my screening with Elodie, who we met earlier.
See, I heard a lot about mammograms growing up, but it turns out Elodie didn’t, because of the religion she grew up practicing. She says if her relatives ever got screened, she didn't know about it. Even though it might’ve changed the course of their lives. Here's Elodie:
“I’m pretty sure my grandmother died of breast cancer, but I don’t actually know. … And then my mom, my mom definitely had breast cancer, and I know that because I took care of her."
That got Elodie thinking about her family history, and how it might impact her.
"There’s, like, implications about my health, as well. … I’m like an only child but don’t know if there’s implications for like, female cousins, or like, I don’t know, I don’t actually know,” she said.
Although there is a hereditary link with breast cancer, Elodie wasn’t super familiar with how mammograms worked. And experts have told me that that lack of knowledge is also part of the reason people aren’t comfortable getting them: When you know how something works, it becomes less intimidating. But when I arrived at Porter Medical on that balmy September day, I was still a little nervous.
As I started filling out paperwork in Radiology, things felt pretty real, and just as I could feel my heart race even faster, in walked my mammographer, Brittany.
“My name is Brittany Ferdinand. I’ve been doing mammo — mammography — for nine years!” she said.
Your mammo tech is wildly influential in your experience of getting screened, both physically and emotionally. But with her broad smile and infectious optimism, Brittany immediately put me at ease.
“So come on in here, Jenn," Ferdinand said. "We just keep the ambiance just really chill, so it’s like calming vibes."
"Let’s start with your right breast, so if you’ll just take your arm and slide it out of that sleeve. … This machine is going to be your best friend. OK? I want you to just lean in with me as much as you can. And I'm gonna start to bring this compression down. We're gonna stop there. Jenn, hold your breath … OK, back right out, that’s one!"
After all this, I exclaimed: "That was not that bad … that was not bad at all!”
And it really wasn’t that bad! Thankfully, nothing like being put on a cement garage floor and having a car run over my breast, which was a relief.
But that was just one shot, and a mammogram includes multiple images of each breast, so Brittany moved on to the next shot.
“I feel so funny asking people to relax their shoulder when I'm literally bringing down compression. They're, like, 'Easy for you to say!'" Ferdinand said. "So basically, what I'm doing right now is pulling all your breast tissue forward and making sure that I have all the anatomy that I need to prove that I have all of your breast tissue on an image."
Your mammo tech may show you photos there on the spot, like Brittany offered me and Elodie. And I couldn't help but think that my breast tissue looked like moon, which Brittany seemed to appreciate:
"I’ve never heard anyone say the moon and it totally does … like the little craters?"
Breast tissue looks like these grayish pocketed swirls in pictures, and this tissue weakens as we age.
So, the younger the patient, the denser the breast tissue — and the greater the chance you may need additional imaging, since it can be harder for radiologists to see anatomy as clearly on the first pass.
That’s why lots of doctors and radiologists recommend that people in the 40 to 49 age range consider getting called back for more imaging as part two of a two-step screening process.
“They may see something in your breast tissue that raises a little like ‘Ooh! We need to check on that' just to make sure it’s not something that they should be monitoring more closely,” Ferdinand explained.
Michelle Aines, the director of radiology at Porter Medical, really doesn’t want the fear of a callback to stop you from taking that first step. Unlike my primary care doc, she recommended ripping the lid off Pandora’s Box.
"Because not knowing isn’t gonna make it go away, the disease is still going to progress," Aines said.
In addition to supporting breast cancer patients for nearly two decades, Michelle is also a survivor. I asked what role mammography played in her diagnosis:
“The ultimate role," she said. "My cancer was so small, I would have never felt it. If it had not been for the mammogram, you know, it wouldn’t have been found perhaps until it was, you know, too late.”
Gradually, as I talked with Michelle, she revealed her own experiences as both a health care provider and a patient.
“You know, there’s times during October, breast cancer awareness month, that as a patient who had breast cancer, like, I don’t want to reminded everywhere I go about it, you know? I’m reminded every day, and so I struggle with that at times," she said.
Still, Michelle says there’s power in sharing your story and raising awareness and community for others.
“I’m so thankful at the same time that the word is out there," Aines said. "Breast cancer doesn’t define you, it’s part of you, but it doesn’t define you … and don’t hog your journey, it’s not just for you,” she said.
And I felt similarly, at least when it comes to screenings. If just one person feels a little more ready to get their first mammogram after hearing about mine, I’m grateful to make a very personal experience public.
I felt relieved as Elodie and I got in the car after the screening.
“The boob squishing is over. The boob squishing is over!” we said.
But I couldn't help but wonder how the experience was for her, given her family history.
"It’s funny, I grew up not wanting to know about things because my religion told me, like, that wasn’t useful, to like developing my spirituality," she said. "And then, turns out, I’m actually a super curious person and I love knowledge … and … I love that I know how that works now.”
Yeah, me too. And I'm relieved to share that I received my results the very next day. They have my baseline and didn’t find anything that needed more imaging. So, now I just wait for my next annual screening.
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The audio for this story was mixed by Peter Engisch; editing by Kevin Trevellyan.