Jennifer Gill Kissel concocted dozens of (lame) excuses for not getting her 40-year-old breasts examined. Then she stopped procrastinating. And she's glad.
December 6, 2009 5:00 AM
By Jennifer Gill Kissel
I wanted to lose 10 pounds before my first mammogram. Not that the technicians would notice an extra slab of flab amid all the flesh they work with. I guess it was an excuse, which we women are experts at when it comes to mammograms. We are procrastinators, martyrs, scaredy-cats and scatterbrains, when convenient. We catch colds and the dog throws up. My friend Kathy has been saying for a year, "I really should make a mammogram appointment." We all say that. Our excuses are as ample as Dolly Parton's bosom.
A stranger named Colleen Reynolds shook me from my apathy. I interviewed Colleen two months ago for an article I wrote about breast cancer. Colleen's doctor found a tumor during her annual mammogram and ultrasound when she was 47. Now she is 49, and cancer free.
Although I had written many times about breast cancer awareness, I never got a mammogram. A friend, MaryAnn, died of breast cancer at age 39; but it was so fast and ugly that few of us processed it for what it was. I had no risk factors. Doing self-exams seemed like feeling for a grain of salt in a loaf of bread (or in my case, a biscuit). My midwife gave me a mammogram prescription last year when I turned 40, but the scrip expired in my wallet.
In October, after I interviewed Colleen for an article in which I encouraged other women to get mammograms, I felt like a hypocrite and had exhausted my supply of creative excuses, so I made my appointment.
If I had waited another month, this story (spoiler alert: it has a happy ending) might never have been written, because I would have been handed another excuse not to get my mammogram.
In November, the U.S. Preventive Services Task Force gave license to apathetic women like me to wait until age 50 for a first mammogram. Chairman Dr. Diana Petitti said, "We're not saying women shouldn't get screened. But we are recommending against routine screening." The group also advises women to consider false-positive results, radiation exposure, false reassurance and pain when thinking about mammograms.
Komen for the Cure (a national breast cancer advocacy and education organization), the American Cancer Society and other groups work hard to get women to stop making excuses. In 1982, when Komen was founded, the five-year survival rate for a woman diagnosed with early stage breast cancer was 74 percent. Today it's 98 percent, in part due to early screenings.
Some women use the excuse that they can't afford a mammogram. But Komen funds a mammogram voucher program for uninsured or underinsured women. The voucher covers the cost of a mammogram and other needed diagnostic tests (call 1-888-687-0505). If you feel a mammogram is a financial burden, you'll get a voucher.
Some worry about radiation exposure during mammograms. They should discuss options with their doctor, and at the very least do self-exams. Some women are turning to Digital Infrared Thermal Imaging, or thermography, in which technicians capture a digitized image of the breast on an infrared heat picture.
Too busy? I spent more time buying a celebratory bagel after my mammogram than I did at my appointment. Afraid it will hurt, you'll find out you have cancer, or you'll be embarrassed to be seen naked? You know the answers: Cancer hurts a lot more. Being seen in your coffin is also pretty awkward for everyone involved.
When I asked Colleen Reynolds' permission to use her name here, I told her she inspired me to get my mammogram and that I was awaiting biopsy results. She said she would pray for me. We talked about the new recommendations and worried that insurance companies will decide not to pay for screenings for women younger than 50.
"If I had waited until I was 50," Colleen said, "I would have been dead."
My mammogram didn't hurt. Instead, I marveled at how such a small amount of flesh could appear so bountiful through the magic of compression. Sort of like a push-up bra, but with a smashed-flat effect.
I left with a pink pen and the disappointing knowledge that I wasn't likely to be mistaken for a squashed Victoria's Secret lingerie model until next Columbus Day.
But three weeks later I was back, performing more breast acrobatics. A doctor wanted a diagnostic mammogram to better examine calcifications in my left breast. Then I was sitting with my robe loosely tied, feeling slightly vulnerable and listening to a doctor recommend a biopsy. "I don't think it's cancer," she said, but she didn't want to wait another year. The word cancer jolted me, because I expected her to use a euphemism, such as "I don't think it's anything to worry about."
I nodded and acted cool. A week later I was wandering through the stairwells at Allegheny General Hospital, realizing how thin the line is between being a person who does not have cancer and being one who does.
My biopsy was more of a disruption than a worry. My insurance company kept insisting I didn't need a referral. (I did.) I was thinking about getting the kids from school, and impending deadlines, and whether my sore breast would interfere with my running regimen.
As I crossed through the doorway from the Allegheny General parking garage to the Cancer Center, which houses the Breast Care Center, I had a surreal moment when I imagined how a woman with cancer feels, crossing that portal linking a world where people simply live to a world where people fight to live.
The Breast Care Center staff are kind and wish everyone good luck. But in the waiting room, I felt like an imposter. A beautiful, tall woman with a cane looked like she had passed through the Cancer Center doors one too many times. A tired looking man gazed through me. I felt embarrassingly healthy.
My nurse, Barb (I think that was her name, but I was a bit distracted), made sure we were both clear into which breast the doctor would jab sharp objects. "You'll lay face down," she said, gesturing toward a cushioned table, "and place your breast in this hole." She pointed to a hole through which an oversized beach ball could easily pass. "Good thing that hole's really big," I noted, looking for a laugh. Barb smiled, but I think she was trained to withhold comment on the size of her patients' appendages.
Then I was on the table, seeking a comfortable position because I had to remain completely still through the photographs, needle insertion and tissue extraction.
Barb fiddled and tugged, placing my breast just so. Once she murmured, "This is really small." I couldn't resist asking, "What is so small?"
"Oh, not your breast!" she replied. "I meant the spot I'm aiming for."
"I know," I said, laughing. "But you have to admit, my breast is small."
After only about 10 minutes of lying immobile -- on my stomach, head turned, left arm against my side, right arm bent at the elbow -- I developed an obsessive desire to wiggle my fingers. My neck was beginning to spasm. My ankle itched. I had to pee.
I started chatting, forgot myself, and lifted my head. Barb, who had so patiently spent the last 10 minutes placing my left breast in just the correct position for Dr. Khatib, all the while emphasizing the importance of not moving, sighed.
If I really thought I had a life-threatening tumor, I might have hyperventilated. Instead, I wanted to see the biopsy needle, a contraption that made rapid chattering noises like a sewing machine. Dr. Khatib worked carefully and surely, extracting enough tissue while keeping the probing to a minimum. Barb laid her arm across my back in case I jumped. I mused that the gesture probably has steadied the nerves of more than one anxious woman.
I gazed at the images of my offending breast, calcifications glowing on the backlit screen. The angle made my breasts look perky, like they did before I breastfed four children.
Just as I was considering gnawing off my numb arm, it was over. Dr. Khatib left and I commented that she was nice. "She's from Jordan," Barb said. "She's here studying 'all breast' for a year, and she hopes to go back and make a difference."
I asked what she meant. "Well, in Jordan," Barb explained, "the government doesn't pay for mammograms unless a woman clearly needs treatment. So women don't always come in until their breast is out to here" -- she held her arm out as if holding a bag of groceries -- "and it's too late anyway."
Suddenly, the idea of beach ball-sized breasts didn't seem funny and every excuse seemed as flimsy as my purple lace bra. I dressed solemnly and walked into the back waiting area where other women, vulnerable in their thin, wrap-around gowns, waited with anxious faces and folded hands. Most looked younger than 50, like me. Like Colleen. Like MaryAnn.
Near the exit of the Allegheny General Cancer Center, there's a wooden kitchen chair, covered with scribblings of cancer patients and their loved ones. Have faith. Be strong. Take one day at a time. On one arm of the chair someone had written, "For all those who suffer." I blinked back tears, and walked through the Cancer Center doors to the outside.
In the grocery store, my ice pack fell out of my bra and landed at the stock boy's feet. "Do you have any rutabagas?" I asked as he reached for the ice pack, while voices in my head babbled, He doesn't know you could have cancer. You don't have cancer. Oh, but you could.
At home I lifted more than five pounds and forgot to take ibuprofen and did everything Barb told me not to. Dr. Khatib had inserted a tiny metal clip in my breast to mark the extraction site, where it will remain forever, a miniscule badge of honor. I touched the spot and scowled at my bruised breast when I showered and thought, You'd better not turn on me. And I thought about the women whose breasts had turned on them; the ones, like Colleen, who had a chance to fight, and the ones, like MaryAnn, who never knew until it was too late.
According to Ms. Purcell, on an average day in Pennsylvania, 33 women receive a breast cancer diagnosis. Annually, 200,000 U.S. women are diagnosed and 40,500 die. Some women younger than 50 will use the new recommendations as an excuse not to get screened. Some of them will die.
Otis W. Brawley, M.D., is chief medical officer of the American Cancer Society. He writes on its Web site, "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40 ... [based on] additional data that the U.S. Preventive Services Task Force did not consider." Komen for a Cure stands by the statement. Don't look for any free excuses from them.
The day after the new recommendations appeared, the Breast Care Center informed me that my biopsy results were fine. I called Colleen Reynolds. Thank you, I said, for everything. We agreed that women need to stand up for each other to save lives. No more apathy.
Just then, my friend Kathy called me on her cell phone. I told her the good news. "I really need to make that appointment," she said.
After we hung up, I called her home answering machine. "Kath," I said, "here is the phone number. Make the appointment."
I got an e-mail from her an hour later: "1:00, Dec. 17."