The Mammogram I Almost Missed

Chelsey Fischer decided to have a mammogram despite the USPSTF screening recommendations. Her choice saved her life.

MammoMissed

October 2015

Every person has several pivotal moments in their life, ones that you look back on and judge your life before and after.

One of my most key moments began with the best $400 I’ve ever spent. We had an extended weekend and decided — on a whim — to spend money we didn’t have and go to a water park. I was playing in the water with my two daughters , Penny and Lucy, when they decided they wanted to “rumble” (on a normal day, this consists of wrestling with whatever family member is closest and slamming them to the floor). When Penny hit the left side of my chest, it hurt, far more than the right.

I was so concerned about it that I made an appointment with my primary care physician immediately. Breast cancer was the farthest thing from my mind. I was 38, I’d never performed a self-breast exam, and, to be honest, I wasn’t concerned about breast cancer because I had no family history of the disease. I was much more afraid of developing Alzheimer’s than I ever was of breast cancer. Yet, when I visited my doctor, she advised that I get a mammogram.

“It’s probably nothing — just a bruise,” she told me. But because I was so close to 40, and because she was aware that the ACR recommended mammography screening beginning at that age, she wanted me to get a baseline check done anyway.

Several days later, I found myself at a breast imaging suite. My results came back almost immediately: my radiologist introduced herself and explained that she had found calcifications throughout my breast. Her recommendation was to do a biopsy.

I’m an engineer. I don’t have time for hedging, and I like to get straight to the facts. So I asked her, “What do you think it is?” And she replied, “I think you have breast cancer.” Needless to say, I went through with the biopsy.

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Again I received bad news. I had cancer, and I needed to have a mastectomy. That was it. There would be no chemotherapy for me, I was reassured.

But when the pathologist’s report came back, it turned out my cancer was more advanced than they’d realized. And it was HER-2 positive, which tends to be fast and aggressive. All of this, plus my relative youth, meant I needed more treatment, and a lot of it.

I remember sitting on the phone crying with my parents. I was so young. My daughters were so young. They were only three and six. What would happen if they had to go through their lives without their mother? I didn’t want to be the tragically dying parent that left them letters on my deathbed.

What would have happened if my physician hadn’t been aware of the radiologist-recommended age for screening and had sent me on my way, telling me it was only a bruise? What would have happened if I had listened to the recommendations to start screening at 50 and canceled my mammogram? I almost did.

While I consider myself an informed consumer of health care, I’m not a physician and I don’t know the intricacies of breast imaging and evaluating the research around when to begin screening. I didn’t think I was even remotely a candidate for breast cancer. And the anti-mammography data swirling in the media made sense to me. The flaws in the data were not explained to me — the media discusses the data surrounding how harmful radiation can be, but it never mentions that the studies used out-of-date equipment and the USPSTF panel does not include any breast imaging experts.

The media writes about the health care costs of mammography but never mentions how little reimbursement breast imagers actually receive from it. And they talk about the anguish that false-positives can bring, but they fail to mention the much greater, more lasting anguish when you do not catch the cancer. Nor do they talk about the flood of relief that comes once you’re declared cancer-free, whether it’s after a biopsy or after months of radiation therapy.

I haven’t had that talk yet — I’m still undergoing treatment. But because of a mammogram we caught the cancer early. With luck, I’ll be having that conversation soon.



By Chelsey Fischer

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