Women know all too well why they delay mammograms

May 22, 2007|By Susan Reimer | Susan Reimer,Sun Columnist

I am late for my mammogram.

Not late as in "running late." Late as in weeks late or months late. Could be a year. I am not sure. I have kind of blotted it out.

I made an appointment -- actually, it was the second or third appointment -- but I didn't keep it. I scheduled it during a week of vacation, but I didn't go. It was raining. I curled up under an afghan and watched a soap opera instead. I'd already had a tooth filled that week, I reasoned. Enough is enough.

Women my age should have a mammogram once a year, according to the best available but still relatively confusing medical advice. Mammograms are not exactly preventive maintenance. More like early-warning maintenance.

Like changing the oil every 3,000 miles or having your teeth cleaned every six months, mammograms are the kinds of routine medical care -- like their children's vaccinations or their husband's cholesterol check -- that women are famous for taking care of. It is what we do best.

But a lot of women my age and my income level aren't having mammograms anymore. According to a study by the National Cancer Institute and the Centers for Disease Control and Prevention, the overall rate at which women are undergoing regular mammograms fell from 70 percent to 66 percent between 2000 and 2005.

There are lots of theories about why this is happening.

Those of us who were scared off our hormone replacement therapy by the last round of research may think the increased cancer risk has been removed. Maybe because we aren't going to the doctors as often to re-up for HRT, we aren't being reminded that it is time for a mammogram.

Maybe we can't get an appointment. There aren't enough facilities in some areas, and there aren't enough radiologists willing to risk the malpractice suits that might result from misreading the grainy pictures.

Maybe we are worried about the false positives. Or worse, the false negatives.

Maybe we have started to worry less about the specter of breast cancer now that we know we are more likely to die of a heart attack.

But maybe we already had a tooth filled or a root canal that week and we are thinking, "Enough is enough."

Maybe we aren't getting our mammograms because they hurt. A very sensitive part of a woman's body is pressed between two pieces of glass and great pressure is applied.

We are led to believe that the greater the pressure and pain, the more accurate the picture. The denser the breast tissue, the greater the pressure and the greater the pain.

Mammograms are humiliating and they are painful. I wonder how many times the X-ray technicians have heard women mutter bitterly that prostate cancer is not diagnosed this way?

Sonograms and MRIs are promising diagnostic tools for early detection of breast cancer, and they don't hurt. The fact that insurance companies are dragging their feet when it comes to covering these less painful and more accurate procedures is particularly perverse.

Medical science is mystified by the drop in mammograms, especially among women 50 to 64 who might benefit most.

The reason seems pretty obvious to me.

susan.reimer@baltsun.com

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