Hardcore Pink

Avon Walk for Breast Cancer, Santa Barbara, CA 2012
Avon Walk for Breast Cancer, Santa Barbara, CA 2012

Tomorrow morning I’ll drive to the clinic, put my clothes in a locker, put on a blue robe, stand half naked while a technician arranges first one of my breasts and then the other on a clear plate, the edge of which will dig into my armpit as she pulls and positions me, hold my breath as she compresses, compresses, compresses my breast until I want to gasp, remembering what I’d managed to forget during the year. Getting a mammogram is intense.

I have been getting a mammogram every year for longer than I can remember. Whatever year it it was, 1988 when I was forty, a few years later, I don’t know. It was when my doctor said it was the thing to do. So I did it. I thought, damn, there’s a test to detect early breast cancer? Why would I not do it? I’m not religious about health practices. I’m not a health nut. But I do the things that are in bold print. Having a mammogram was one of those things. Besides, I love my pair. I’m not really gorgeous. But they are.

To me, early detection of breast cancer is a feminist issue. It is also an issue of economic and social justice. When I see a mammogram-o-bile out in a neighborhood, I feel happy. I feel like that big van is helping my people! I want that. I want every woman to have what I’ve had for years. Annual mammograms. Education about breast self-exam. Knowledge and care.

So when the new breast exam guidelines were issued, I was surprised. The U.S. Preventive Services Task Force published guidelines that were a festival of equivocation. Mammograms for women ages 40 to 50? Depends. Maybe. Need to do a risk assessment. For women ages 50 to 74? A biennial mammogram is sufficient. Over 75? Nope. I read another article published by the American Cancer Society that said mammograms over 55 should continue only if a woman is in good health and expected to live another 10 years. Well, I plan on living to at least 100, so get ready to see my 90-year old pair at the Mammogram Shop. I might be decrepit but they’ll still be fine. I bet my life on it.

The same American Cancer Society article recommended against self-exam and clinical breast exams.

I’ll just let that sit there for a minute.

Basically, the American Cancer Society is saying forget all those brochures, toss out the little instructional cards, just never mind about the breast self-exam. The stats don’t warrant you worrying your pretty little head. And, furthermore, the likelihood of your doctor finding anything suspicious on a clinical exam are so small that it’s not worth doing.

So I thought about this. I’m a big believer in statistics. I understand the concept of risk assessment. And I am really into the overall notion of one size does not fit all. I appreciate the sophistication of analysis, the nuanced guidelines. The message from the American Cancer Society and the Prevention Services Task Force is that we are going to be strategic about all of this.

This should be a good thing, an advancement of science. But it doesn’t feel that way to me. It feels back burner to me. It feels like never mind. It feels like we thought breast cancer was a big deal but now not so much, well, only for some people, like those with the BRCA gene mutation, but probably not you, so don’t get upset unless you have to.

In response to  that tangled web of nuance and equivocation, I say this: take off your shirt and your bra. Look at yourself in the mirror. Raise your arms over your head and look at each of your breasts. Feel them. Know them. Know them on Sunday. Know them on Friday. Love them as much as you love your face each morning. Make your doctor look at them. Make her look at them the way a dermatologist uses a microscope to search for skin cancer, inch by inch. Don’t let them or you be waved off as statistically insignificant. Get the mammogram.  Hold your breath and gasp. And then go celebrate.

It’s what you and your precious breasts deserve.



4 Comments on “Hardcore Pink

  1. Amen to this! I don’t get it. I am a breast cancer survivor. I found my own lump. I saved my life by doing an exam. And by getting a second opinion when the first doctor told me I was fine after a negative mammogram (young dense breast tissue) rather than biopsy it to be sure. Honestly, we have to be our own advocates despite what the ACS says.

  2. (Stopping by from NoMo – hello there!). Isn’t it frustrating when the information shifts from what we’ve always heard and based our practices on? I find that it makes it hard to trust anything, as it’ll probably change anyway! Thanks for sharing your thoughts in such a clear and level-headed way – much appreciated.

  3. I’ve been struggling with those guideline shifts and I think at bottom they are saying what you say: know your breasts, watch for changes. They just can’t claim evidence that self exam and mammograms starting earlier for women with no know risk factors are the best way to improve survival. I’d like to see more attention paid to prevention than to detection. So do we do more mammography than might be necessary or do we spend more money on research in prevention? If that shift actually happened, I’d be all for the new guidelines. But of course that’s not how health spending works. There’s not much logic in it. Get your cholesterol checked too while you’re at it: you’re still more likely to die of heart disease, though for some reason we don’t fear that as much.

    • I asked the mammogram technician what she thought of the new guidelines. She shook her head, “I don’t like them at all. After all we did to finally get annual screenings.” It does feel like a step backward to me even though I know it’s rooted in ‘science’ and statistics. Anyway, I was glad for my annual ritual today.

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