Mammogram emerged in the mid 1960’s and by the late 1970s mammography was widely used, but had become a source of tremendous controversy. On the one hand, advocates of the technology enthusiastically touted its ability to detect smaller, more curable cancers. On the other hand, critics asked whether breast x-rays, particularly for women aged 50 and younger, actually caused more harm than benefit. Despite the publication of hundreds of research studies, this dispute about mammography persists.
I recently received a letter (and a small pile of explanatory leaflets) to invite me to go for breast screening – as this service is available every three years for women over 50, like me. On reading the letter I could feel the value of having regular screening as part of taking care of myself.
The Breast Screening Clinic where I had the mammogram was clean and tidy. In a timely and efficient manner I was ushered into a very small room with a coat hook on one side and a small plastic stool on the other and was asked to ‘take off all my clothes from my top half’, and to sit and wait on the stool until I would be called for the screening. At this point the female radiologist said nothing further and I was left in the room to undress myself. As I undressed I felt chilly, so I put on my cardigan and sat and waited.
I was called into a large clinical room with only the mammography x-ray machine in the middle. The room was chilly and I mentioned that to the radiologist who replied ‘I’m always hot – please remove your cardigan’ and then she asked me to stand in a certain position and explained briefly what would happen with the mammogram: how the breasts needed to be placed in between two plastic plates. She showed me how to do this and then the machine slowly squished my breasts (horizontally and then vertically) like a wrench with a nut – which was very uncomfortable.
I expressed how uncomfortable my breasts felt to the radiologist, she seemed perturbed although she didn’t actually say anything to me. I was curious and asked her if I was the only woman that had expressed how uncomfortable it wasand she said ‘well yes, most women come in here, they know it is uncomfortable and they just get on with it as quick as possible’.
Moments later the mammogram was over and I was ushered back into the little room where my clothes were. As I walked to the room I cried.
I realised I was crying not only because it had been an extremely uncomfortable procedure, in non-conducive surroundings, but also and more so because I realised that this was an experience where I couldn’t ‘blame the National Health Service (NHS) or the radiologists for this way of providing mammograms’. Most women (myself included) hadn’t expressed what they felt or hadn’t consistently raised concerns about the way these mammograms are undertaken (e.g. in a cool room or how truly uncomfortable they are).
Before I left the clinic I sat in the waiting area and filled out a ‘comment card’. I suggested more warmth in the rooms and more tenderness in the way the mammogram is undertaken, particularly in the dialogue between the two women (patient and radiologist).
What I did wonder though is why is it that women generally have put up with screenings such as mammograms for so long when they seem so arcane and so unsupportive to the delicate tender nature of women and women’s breasts?
With my recent experiences of having women’s health checks – a cervical smear screening and now a breast screening, I wondered if in time more and more women raise their concerns and ask for mammograms to be undertaken in a different way (assuming mammograms continue to be undertaken in the future), with more conducive surroundings, whether we may have breast screening performed in a warm room, having a warmed dressing gown to put on while the procedure is being undertaken (or just up until the moment the mammogram is undertaken), with a sitting room after to sit and have a cup of tea before carrying on with the day and with a feeling that we can take all the time in the world to honour ourselves deeply. Furthermore, it just may be that if more and more women expressed their concern or discomfort in having mammograms that other alternative breast screening methods (e.g. breast screening thermography) could become more commonplace.
My point in sharing this experience here is not to have a dig at the radiologist or at the local health services. I work in the NHS and I’m acutely aware of the amount of specialist training those who provide and run these services receive and the pressures upon the NHS to deliver within very tight budgets. It is more that for too long we (women in this case) have put up with things as they are, without consistently asking whether there is another way. In the case of mammograms for instance, it is not just the recipients of mammograms who question them (and who have an uncomfortable experience), but the people who provide these services may also question the use of mammograms, as well as realising how uncomfortable they must be for the recipients. I certainly feel more responsible and empowered to express my feelings from here on.
by JK, UK
Barron H. Lerner, MD, PhD (2001), “To See Today with the Eyes of Tomorrow”* A History of Screening Mammography, Background Paper for the Institute of Medicine report: “Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer”. Institute of Medicine. Retrieved October 26, 2013
Cancer Research UK. Mammograms in Breast Screening – Retrieved October 26, 2013
NHS Choices. Breast Cancer (female) screening – Retrieved October 26, 2013