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Dec. 4, 2020

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First mammogram an easy rite of passage

Most doctors recommend age 40 for baseline image

By , Columbian Web Editor
Published:
9 Photos
Amy Libby, The Columbian's web editor, gets assistance from radiological technologist Jenni Barr while getting her first mammogram at Kaiser Permanente's Cascade Park office in August.
Amy Libby, The Columbian's web editor, gets assistance from radiological technologist Jenni Barr while getting her first mammogram at Kaiser Permanente's Cascade Park office in August. (Amanda Cowan/The Columbian) Photo Gallery

Like a lot of women, I put off my first mammogram. Kaiser Permanente started pestering me to make an appointment approximately 13 seconds after I turned 40. That was in 2018.

But then my mom was diagnosed with uterine cancer. I was promoted to a more demanding position. My husband changed jobs. And, I admit, I’ve been avoiding doctors since I broke my shoulder five years ago. (Seven months of X-rays and physical therapy will do that to you.)

I embraced the “I’m too busy” excuse for two years — until editors here at The Columbian encouraged me to make that long-delayed appointment and write about it. I agreed to bare it all in hopes of convincing you to get your mammogram, too.

The appointment

Making an appointment was easy. I was able to go online and set a time and location. I could have even chosen to go on a weekend.

I received an email instructing me on all the things I wasn’t supposed to do — like wearing deodorant or lotion — and reminding me to wear a mask. Photo Editor Amanda Cowan came along to document my mammogram. She and I both went through the gauntlet of COVID-19 safety procedures, including temperature checks and questions about international travel.

That morning I was so nervous that I changed outfits three times. But it didn’t matter what I wore because I had to exchange it for a hospital gown anyway. (For a mammogram, you have to strip naked on top, so wear something easy to take off and skip the dresses or jumpsuits so you can at least keep your pants on.)

Radiological technologist Jenni Barr led me through the process, which is really simple. It mainly involves standing still and holding your breath while one breast at a time is compressed. Barr helped position me so the imaging machine could do its work.

I’d been told that women with large breasts — I’m a 38DD — find mammograms more painful. My mom, who has cystic breast tissue, always complained of pain during her screenings. I was expecting to be miserable.

But it just didn’t hurt that much. Each of the four images took less than a minute to capture. The whole appointment took maybe 20 minutes, and only lasted that long because I was asking questions for this article. While the pinching and pressure were uncomfortable, I wouldn’t call it pain. The most painful part was trying to get my left arm — and the shoulder I broke — into the correct position to take one of the images.

“It’s actually pretty rare for someone to have a painful experience,” said Dr. Belinda Holland, a Kaiser radiologist based in Portland.

She recommends making your appointment for early in your menstrual cycle and taking Tylenol before your appointment if you think you’ll need pain relief. If the machine’s compression causes pain, tell the technician, she said.

The most surprising part of my screening was how exposed I felt. I think my next mammogram will be less stressful because I won’t have a photographer tagging along.

Recommendations

Not all experts agree on when women should have their first mammograms, which is how I rationalized delaying mine. The U.S. Preventive Services Task Force recommends women begin screening at 50, while the American Cancer Society says 45. Most doctors, however, tell their patients to get it done at 40.

“In general, for most women with standard risk, starting at age 40 offers the most protection,” Holland told me in a phone interview after my appointment. Incidence of breast cancer in women ages 40 to 45 is about twice that of ages 35 to 39.

In Clark County, the numbers are striking. According to 2017 figures, the most recent available from Clark County Public Health, the rate of breast cancer in women age 40 or younger is 15.7 per 100,000 population. For women in their 40s, the rate is 166.3 per 100,000.

Holland — and Kaiser Permanente — recommend annual mammograms, even during the pandemic. She said if you pick a date — a birthday, a holiday, when your car tabs renew — you’re less likely to forget.

Holland also stressed the importance of talking with your primary care doctor.

“Everyone has a different story,” she said. Your doctor can help determine if you’re at higher risk and should be screened even before age 40.

Risk factors include a family history of breast cancer at a young age, BRCA gene mutations, or receiving chest radiation for Hodgkin lymphoma as a child. That said, 75 percent of breast cancer diagnoses are in women without a family history of the disease.

At the end of my appointment, the technician told me that it isn’t unusual for a radiologist to see something in a scan. This isn’t a reason to panic.

“At your first mammogram, we don’t know what a normal mammogram looks like for you,” Holland said. “Because of that, we’re extra cautious.”

About 10 percent of women are called back for more imaging, but the radiologist usually reviews the scans and gives you results at the same appointment.

“The majority end up being normal,” Holland said. “Occasionally we may find something (and) recommend a breast biopsy.”

In my case, I received good news within a week: My mammogram was normal.

Now it’s time to put a note on my calendar for next year’s screening.

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