Thursday, October 14, 2010

Write Pink! Deciding for Myself {Bigger Picture Moments}

File:Mammogram showing breast cancer.jpg
{ photo credit Wikimedia Commons }

Just like Hyacynth I am a researcher. However I don’t have her journalism background, mine is almost worst. I was a biology pre-med major and I spent over 15 years volunteering and 6 years working in hospitals. So I don’t just read mainstream media reports, I actually download and read case studies, scientific journals and the CDC’s Morbidity and Mortality weekly when I have to make a health care decision.. My husband and my doctor both laugh at me about it (probably pointing out I should have actually gone to med school with all the research I do), but I believe when it comes to mine and my children’s health I need to be an educated consumer. I never take what a doctor or pharmacist hands me and blindly accept or follow instructions, with good reason. I firmly believe that you need to be your own advocate.

My family history tells me I have a 20% chance or higher of developing breast cancer. That’s based mostly on genetics and the high probability that I am a carrier of one of the BRCA genes. My father’s mother had breast cancer. If her’s was genetic it’s a high probability that gene was passed to me.

(quick genetics lesson for non bio geeks. Boys = XY Girls = XX. Let’s pretend the pink X has breast cancer. My grandma (XX) gave one X to my dad, so he is XY. He gave one X to me, so I am XX)

My grandma’s cancer, as far as I know (we don’t discuss it) was post menopausal, which makes it less likely to be genetic (I think). My mother in law also had breast cancer, her was not post menopausal, which (again, I don't have the references) makes it more likely to be genetic. Meaning my daughter’s risk is even higher than my own if it is passed through the fathers X. A worrier by nature I have not had genetic testing done. It would provide no relief or benefit to me or my mind. (for a great read on family history and two members making opposite choices about testing read this)

I have made other conscious efforts to reduce my risk:
- I work hard to maintain a healthy weight.
- I try (I fail often) to eat a variety of healthy foods.
- I exercise
- I breastfeed
- I avoid soy
- I try not to worry that everything is cancer, or will cause cancer, I try to just live.
- I choose non-hormonal (Paraguard copper IUD) birth control
- I do breast self exams (not enough)
- I see my OB yearly and have her do an exam
- I will have regular mammograms 

The last 3 are tough for me. I have fibrocystic breasts . I find lumps all the time. Knowing that is important, but it also sometimes makes me lax in checking. I have twice had ultrasounds to confirm that it was just fibrocystic changes and not something worse. However that habit, and the type of breast I have, also put me at higher’s a fine line to walk.

My first OB (who I have no respect for) didn’t think I was at risk since my grandmother was post menopausal, but decided we should start mammograms at 35, mostly because it's what I wanted. My current OB, who I love and respect feels the same way.

I’m 33.

I have a breast surgeon. I have seen him for both my scares and follow up, I respect him and think he is a great doctor. When I saw him for a follow up after my latest scare (this spring) he said to me:

“Well with our family history combined with your own I would recommend you come back at 35 and start Mammograms, but I guess some people say we aren’t supposed to say that anymore, so it’s up to you.”

(I am trying really hard here to not get on a soap box and rant)

He is referring to this the US Office of preventative medicne’s statement that mammograms shouldn’t start to 50. Some of the myriad of reasons are: they don’t save enough lives, they don’t catch enough cancers, they cause undue stress worry and in some cases procedures that women wouldn’t need. So far all that statement has done is create a firestorm of controversy. Make doctors (like mine) preface their plan for care, and confuse a lot of women.

Google when should I get a mammogram. Go ahead, I can wait.

Do you have a definitive answer? Do you feel confident in that choice? How many different answers did you get? What age did you find?

Women’s says 40 (ironic no?), and every 1-2 yrs after, earlier if doctor and history believe warranted
American Cancer Society  (they have strongly spoken out against USPSTF) every year starting at 40
NCIS: 40
Radiologist: 30 with history, 40 everyone else

So thankfully, it seems most people still disagree with the government. I am even more grateful to have doctors that work with and respect my opinions in making my health care decisions. If your doctor doesn't, get a new one. NPR did a follow up on the controversy it this week and this was my favorite quote:

"My God! If it is cancer, wouldn't you want to know?" she says. "And if it isn't cancer, hooray! And so you were uncomfortable for a minute and a half. I don't get it. I don't get the big deal. The downside seems to me to be nonexistent."

So what if the studies vary from no benefit, 2% or 29%...isn’t even 1 life worth it? There are people who do not believe and do not get mammograms. I’m okay with that, because it’s THEIR CHOICE. Made (hopefully) with a doctors supervision and guidance. My choice? Is to get screened. Every year after 35 if I am not pregnant or breastfeeding.

My point is it needs to be my choice, my doctors choice. The decision of those that have looked at my medical history and who have studied the disease. It should not be decided by someone who a) has no breasts and b) has no medical degree. I would never tell my husband, or any other male, when they should start having their prostate probed or how they should do it.  It's about knowledge, and I don't have knowledge of the prostate, although I do have more of a medical background than most senators.

I believe mammograms save lives, 
one of them might even be mine.

* Head over to Hyacynth’s for a week worth of great posts on ways you can prevent your breast cacner risk. Every comment this week will be entered for a chane to win Pigitail Pals tee.

How are you reducing your risk for breast cancer? Link up your thoughts here (or on our Facebook page) and you can be entered to win glass drinking straws from Strawesome!



Julie said...

I love all the awareness of what we can do to prevent breast cancer that is being spread around. Like you, I have family history working against me, and I have had a few scares in the past few years.

I encourage people to remember, as I lurk through lots of write pink blogs and posts this month, that some things that are true for most are not true for all, such as the recommendation to avoid hormonal birth control.

For some of us, hormonal birth control is a treatment for a problem, as opposed to simply a means to prevent unwanted pregnancy. For those of us who are in this boat, NOT using the artificial hormone is actually more of a carcinogen than using it for various reasons.

I love the posts I'm seeing and I love the spirit behind them. I just encourage everyone reading to remember that each person is different and it is between you and your doctor what is right for you, and what accounts for prevention vs. increased risk.

Melissa Haak said...

I can't respond to Julie directly but I want to make sure everyone hears this.


That was kind of the point of my post, it may have gotten buried in my soap box (sorry!). Everyone needs to make the choice that is right FOR THEM based on THEIR history and what THEIR DOCTOR feels is best (not yelling, just need emphasis). No one else, not a blogger, a friend, or the government should tell you how or what to do to your body to keep it healthy.

Thanks Julie!

Melissa said...

Read it. It makes me think, I have no history of breat cancer in my family that I know of, but I am committed to keeping myself and my family healthy as possible.