It’s the little things – Breast Screening – Mammogram

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

References:

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

153 thoughts on “It’s the little things – Breast Screening – Mammogram

  1. I too have had a mammogram to investigate a lump I found in my breast a few years ago. Like your experience, JK, I found it rather cold and clinical but I also found it very painful as a procedure – so much so that even though I consider myself to have a high pain threshold, I could physically not hold back the tears as the procedure was happening. But what was interesting was that this was ignored by the clinicians and things went on as if nothing was happening. Also the main door to the procedure room opened out into a busy corridor so when a nurse would come in or out then there was not much privacy offered here. I felt these details made the situation a lot less supportive and as a result am certainly not keen on going back again to have this repeated. I did try to express myself and asked if there was any alternative ways to handle this, but they were so busy and the answer was simply ‘this is just the way it is done’…

  2. Thank you JK for this simple article that actually speaks volumes – what you have highlighted is the lack of expression from women and how we have put up with things without expressing how it feels and asking for support and adjustments to how some of these procedures are done.

  3. Knowing that the mammogram procedure will be cold and unwelcoming we harden our body and, as a result, the mammogram is more uncomfortable than it need be. When we are relaxed and welcome the procedure as part of our self-care it is a very different experience.

  4. A great example Jane of how we put up with things as they are, even when they are painful or uncomfortable accepting it is the way it is. If we learnt to honour our body more and express the truth of how we are feeling we initiate and call for a deeper level of care with ourselves and with others, providing an opportunity for others to also consider and feel for themselves. The more women speak up about their experience the stronger the call for true change.

  5. Speaking up from a loving place when we sense things are not as they should be, allows us to honour our feelings and affords others the opportunity, if they so choose, to reflect on the services they are offering.

  6. The more we listen to and honour our bodies the more they share with us, they really are amazing.

  7. It is indeed very sad that this abuse for that it truly is, is accepted by most woman as simply the way it is and treated as a thing to ‘get it over and done with’. In many ways this is a reflection of the low level of self-worth most woman have for themselves which is even sadder to see.

  8. It is always important to express our truth, I developed malignant melanoma on my skin in an area that had received radiation from mammograms, since then I have chosen to have thermal imaging, ‘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.’

  9. I have had a few uncomfortable mammograms, but prefer ultrasounds to check my breasts, however these aren’t normally available on the NHS. I had breast tenderness and a lump was found in my breast only a month after a clear mammogram. There are false positives and negatives in any procedure. We need to be vigilant ourselves and not give our power away to a test in the belief we are in the clear.

    1. Absolutely agree Sueq. The more we get to know our body and the intricacies, and understand how it responds in life, the more we are on the front foot when it comes to signs, symptoms, etc. I knew recently that something related to my minerals was ‘out’ yet I wasn’t completely sure what – but I started to want zinc, and seaweed. Once I had had the mineral tests, yes I was deficient in zinc for instance – I knew as I was listening to my body and the tests simply confirmed it.

  10. This feels like yet another area where we put up a protective front and don’t express what is really going on. It’s like we are all colluding to maintain the status quo which is crazy when we have the power to change our experience of this procedure.
    I had to have a mammogram last year because of a cyst on my breast and had an interesting conversation with the radiologist and have to say that overall the experience felt much less intrusive and uncomfortable than previously at least partly because I asked lots of questions and felt part of what was happening rather than just having it done to me and feeling powerless which is always more painful.

  11. Yes there is something about women that we think we can’t say we don’t like something because it would make us look weak or annoying and that a strong women just gets on with it and does whatever is asked of her. I feel it is time for us as women to reclaim what being a women truly is and that there can be a lot of tenderness, delicateness, care and love in that without it being weak, actually it is very powerful.

  12. ‘Do you want breast cancer? Well then get on with it… you are lucky the NHS offers this procedure to women’ has been the reply when I have commented on women showing love towards themselves. It’s interesting and something I now observe the reactions that can up in others when we choose love for ourselves.

  13. I have found that when I have had a mammogram expecting it to be painful, it was, but when I went with a feeling of deeply caring for my body it was a very different experience, slightly uncomfortable but not painful.

  14. Amazing – if we don’t speak up when something is wrong then how can things change? It doesn’t make sense that women all over the world put up with an uncomfortable and painful procedure, without asking for more care and attention to details to be put in place. What if the most uncomfortable experiences in the world don’t have to be this way?

    1. I agree Meg – a lady I spoke to who offers womens services said women rarely complain – so how do they know the current system is not working if we don’t speak up?

      1. True, I think part of the problem is acceptance – if we go into something expecting it to be uncomfortable and to hurt and we just accept that’s the way it is then we don’t see the point in speaking up. But I’m not sure a routine test should ever be painful or barbaric or leave you crying after.

  15. I can remember when I had my first pap smear at about the age of 20. I didn’t know what to expect and nothing was explained to me. The procedure was excruciating and the lack of communication around what was happening made it more difficult. I left the surgery feeling traumatised and I avoided having another pap smear for 10 years. When I did go for my second pap smear it was a totally different experience, the doctor was very caring and explained all the steps they needed to take and this helped me to relax and the procedure was not nearly as painful. It took the same length of time but was a very different experience.

  16. Hi Jane, I love the very valid points you have made here. I have to admit to never ever having a mammogram for all the reasons you described in your experience and I am over 60. To go through such humiliation and extreme discomfort when it is not certain that it is doing more damage than good seem ludicrous to me. It seems that the health system has invested so much money into these machines that they are not wanting to discover that this process may be counterproductive. I agree it is time to voice our concerns.

  17. Jane I love your blog, a reminder for us all to be more responsible for our own care and the manner in which they are undertaken, the mammogram room is always freezing cold, and I know in the past the words you just have to ‘grin and bear it’ came to mind, as if I had to put up with it for the short time that it took, however I now realise how dishonouring that is for me as a woman, and looking after myself and speaking up, means the radiologist is more aware of the situation.

  18. What is shared here is very true, we, as women could say how we feel with how medical procedures are and how they are carried out, but could the reason we don’t speak up be because there are many things in our lives that we don’t talk about or share, that soldiering on has become a way of life, that just maybe isn’t the true way to live?

    1. Well said Leigh – if we are living with a degree of self disregard and not speaking up then this is just another of those things we put up with when deep down we know it isn’t true and is not an honouring thing.

  19. What I love about you Jane is you are not afraid to speak your mind, you do it in a way that is both intelligent and warm, critical yet well rounded and never offensive, I really like your style, I hope to meet you one day.

    1. I hope to meet you too Sarah in person. I feel we have met through the comments and the blogs. And yes, Im willing to give expressing a go, in a practical and real way and I always learn from it.

  20. This is a great blog Jane and I can relate, not to having mammographs but to the fact many doctors are rushed, hardened and protected. Not that it is their fault because I know medical training is intense and also the amount of people with problems they see, this must be intense. The whole way we are working together though could be different as you say. I think everyone would like a doctors consult to be more open and tender yet we think it is the way it is or we do not even think about it at all. Yet as you say this does not have to be the way and we can speak up, express and share a different way. (I love the idea of dressing gowns and a warm room!)

  21. Great blog Jane, I too find mammograms an uncomfortable and painful experience, and have explained this before the procedure begins, I was delighted when one of the radiologists heard my words and said “lets see what we can do” and she tilted the machine and was gentle in her manner as well, and it hardly hurt at all. It does take a little longer, and this maybe why there is a reluctance by some to be more accommodating, and I always speak up now as I know I am not being loving by remaining silent.

  22. Thank you Jane for questioning the responsibility that we all have in situations like this to speak up, not only the recipients of the service but also those providing it. Taking the opportunity to engage with those who are delivering it including the receptionist is a great way to start the dialogue. If more time was allowed e.g. to recover afterwards with a cup of tea this would also open up opportunities to interact with other women going through the same procedure whereas my experience has been of other women avoiding eye contact as they steel themselves for what is to come.

    1. I agree Helen. I observed in that clinic that the women wanted to come and go as quick as possible, like we didn’t want to hang around a clinical cold environment for any longer than was necessary.

  23. I was reading another article today, it was actually written by you too Jane on Mastitis, it included a huge amount of shocking statistics on breast cancer and the massive funding that has been dedicated to cure cancer since 1991. I couldn’t help but think if only a fraction of that funding went towards designing a machine that was less invasive and less dangerous and the warmth in the room being a simple adjustment, it really does expose how we are driven to solutions and not looking at the process and energy we take to get there.

  24. It is only when we call out that which is not supportive and loving changes can take place. It may be in the way a mammogram is carried out or it may be in the way we have been spoken to or witnessed another being attacked, whenever it is abuse to a body it needs to be called out. This is something I am paying attention to in all areas of my life to support myself and my wellbeing.

  25. It is great to hear you expressing your response and concern here Jane. How is anything known in our relationships with each other no matter how we meet if we do not express about what we are feeling. When a service has lost its connection and true purpose of what is delivering i.e. people are not the focus, and we are all accepting it including the people working in the service how will it change?

  26. Reading Jane’s blog really is a confirmation of the importance to speak up when I feel to not in reaction but simply as it is. I have held back from communicating how I feel for so long and it has deeply hurt. I cannot stop myself from speaking up because of another’s reaction. What I have come to realise is that if I am feeling to share something so are others.

  27. Great point you are making here Jane, this ‘grit your teeth and bear it’ mentality and that women are trained to endure what we like to call ‘life’, does not serve us women to truly honor our precious and delicate nature and be who we truly are. And this in itself leads to a lot of health problems and of course a lot of other issues that we are facing today in society, where women do not speak up but just grit their teeth and bear it.

  28. I recently had an MRI. Having had one before, it was not a new experience, but there was something almost overwhelming that I felt as I was ‘slid into the machine’ for the scan. I felt an enormous anxiousness – yet it didn’t seem to be from me. What I realised, was that whomever had been there to be tested prior to me (and it could have been more than one person), was in enormous fear and anxiety. This feeling still permeated the machine and the bed I lay upon.
    It took focus with myself and my body to readily settle and drop into a deeper state, that I could be still for the scan.
    What was great following, was to open up a discussion with the technicians present about the number of highly anxious people they may see, and how the smallest care in detail (of a blanket placed and verbal assurance) can make the world of difference. I got the sense that few people opened up such dialogues with the technicians – they seemed a bit relieved to be able to be open about the fact that they deal with huge fear and anxiety every single day.
    Our whole healthcare system deserves to be supported in the ways you describe Jane. Technicians need to feel supported also in dealing with all of this, that the paradigm of what true support for patients entails, can also shift.

  29. Thank-you for sharing this Jane. Whilst I’ve not experienced a mammogram, what you describe sounds cold, hard and lacking in personal connection and true care. As you’ve said, not to blame any technicians or such – the whole way of testing and treatment could be so much more, and everyone deserves this.
    And what of the woman who also has serious concerns about an existent lump/tumour(s) and what her test may then entail in terms of treatment or surgery?
    We do need to speak up, all of us.

  30. Thanks Jane for your blog as well as everyone for your comments. I am having my first mammogram next week. I was having a pap smear recently and my nurse was saying that at 49 I could certainly have one now, and not have to wait until 50. The next day I booked it. Not because I am worried about breast cancer, but because it felt right for me. There is no hesitancy in me at all having this scan, although I have to say I am not a fan of discomfort, so that side I am not particularly looking forward to. But in term of having this is part of my self care it feels an important addition as I approach 50 for that reason I am actually looking for to it.

  31. This article is gold, this conversation needs to be had, if something as simple as a dressing gown and some heating might make woman more likely to have regular checks then this possible prevention may save money down the track.

  32. Re-reading this today Jane I can feel how although some of the suggested changes could be described as little things that the message that is being conveyed when women express how they truly feel in a self-honouring way is huge and much needed in our world today. Thank you for starting the conversation, sharing your experiences and inspiring others to also express.

  33. Having a mammogram in warm surroundings with a gentle connection to the radiographer can make a world of difference as can how we take ourselves to the session. If we are anxious and not wanting to be there then the hardness and tension will be felt in the procedure. If we are open to caring for our body, tender with ourselves and remember the Gentle Breath then a stressful and painful procedure can become a brief mild discomfort. I have experienced both ways!

  34. Hi Jane, this is such an important blog for all women to express how they feel about the support with such procedures. Reading it now, two years after your blog is published, I am still hearing how other women in other places in the world have been experiencing the same as you have shared. Even though I haven’t had a mammogram myself yet, I can feel how shocking this is for all women. It is time that we raise this awareness and express how we feel and how unnecessary this is for women, and that it needs to change.

  35. Everything about your blog makes sense Jane and even more gets you thinking why more women are not prepared to speak up about the unnecessary discomfort and coldness (both literally and metaphorically) of the experience you have shared. It is so important to share as you have that such an unpleasant experience is majorly unnecessary and that actually, if there was true care, the experience could be very healing, because of the fact that the very impulse to get breasts checked is a caring and self loving gesture. Instead that gesture is discouraged by the quality of care offered by women to women. It seems crazy!

  36. You bring awareness to a very important topic Jane. It is great to realise we have a voice and do not have to accept everything as ‘just the way it is’ but can voice how we would feel it would be truly supportive to do certain things. I love the idea of the warm dressing gown and warm rooms. These procedures need to be done but do not need to be a horrible experience.

  37. Jane, I have just enjoyed re-reading your blog and I too agree that there can be changes made in the system that bring more warmth and care and connection between those of us going for screens and those of us that do the screening. At the start is not the most pleasant experience to have (the mammogram) and so any areas around it that can bring in the support can only make the experience more pleasant. I love the thought of a warm gown and the cup of tea, such simple things that hold and offer support at a time when a woman feels particularly vulnerable. Great that you filled in the feedback form and let them know – as a collective, we all need to give practical feedback so that such changes can be instigated – it is only when we actively use our voices that we can then work together to make the changes happen!

    1. Henrietta I too love the thought of the warm gown and the cup of tea. I was in Emergency yesterday withy broken foot and placed on a very cold bed in a chilly room (it was a sizzling 34 degrees outside and I was in my summer finery). I said I was feeling a bit chilly and the nurse went and got me a warmed-up blanket. It was such a surprise to be met with this warm blanket. A really delicious experience. I expressed my big appreciation!

      1. Lyndy this is lovely to hear about the warm blanket appearing at a time when you needed the warmth in more ways than one! And it has reminded me that when I worked at the local big hospital, they had these massive blanket heaters (like ovens for blankets) and we were asked to keep them always full and replace any that were taken out. I used to like pulling warm blankets out for the patients and tucking them in with them. To keep warm is such a key thing for the body to be able to relax and heal and to feel safe, especially in times when we are feeling unwell or have hurt ourselves.

      2. Totally Henrietta . . . and nervous, if hospital is a pretty new experience for you. I love to hear about you tucking people in with such love and care in those warmed up blankets. I am amazed that hospitals have thought of this. Much appreciation to them. I could talk about warm blankets all day.

  38. All change starts with voicing our concerns. Very inspiring to not settling for less than what we know is to be right, even if we have a belief we have to put up with it otherwise we are pathetic. There is nothing pathetic about asking for a more supportive environment otherwise we might as well be cave men.

  39. My next breast screening is approaching, it will take place at the end of this month.I am not looking forward. It is not in the clinic as was yours, Jane, it’s mobile laboratory, always cold. I found the procedure extremely uncomfortable, painful and even though I wasn’t crying after I surely could.
    You are right, Jane,we need to stood up and write comments and be active in asking for more nurturing and loving ways of treatments. Even on a tight budget people still can be tender and supportive.

  40. The other day I had my mammogram, it is part of my self care and in the Netherlands this service is once in two years for women 50 years and older. I had done some breast screening before because my mother died of the result of breast cancer so I know the procedure. Just like you I have filled in a feedback form as it felt cold, no welcoming, no connection and more. I told the woman who was helping me in how to stand etc. how cold the room felt and (her hands) she just responded with ‘yes my colleagues have lowered the temperature because they felt the room was to warm for them’…really, I stand there with no clothes on my upper body and the airco is blowing cold air in the room and then she added ‘and of course we donot want the women to faint.’ I just wrote to them how it would be when the room would be warm, the welcoming would come with connection and care, when the waiting room would have comfortable chairs and something to drink etc. We are all WOMEN, we could support each other immensely.

    1. I am glad that you filled in your feedback form Annelies. How beautiful it would be to have the waiting room and the mammogram room warm and welcoming. As you say, we are all women and we could be supporting one another.
      The battle of the air-conditioning seems to be one we all encounter. At one of my jobs the boss who has about 5 different serious illnesses and is on many medications, has the aircon on at arctic temperatures. One comes out of 30 degree summer heat into a freezer zone and the children are sometimes shivering. When I have drawn his attention to it he just ignores me and says that he is hot. He is hot because of his illnesses and conditions. What can you do?

      1. Spot on Lyndy – and in some countries they also seem to have this perverse competition of who can get their office coldest with aircon during the hot summer months, and so they crank the aircon as you have described, to arctic temperatures and everyone has to wear sweaters and jackets inside. The cold might work to cool down an overheated person, but when the body is cold, it is harder to relax and trust and it is so much more difficult to be still and focused – key ingredients for quality work, learning as well as healing.

      2. Absolutely Henrietta! The body does not like to be cold in that way. It does not mind a brisk walk in frosty weather when one is well-clothed and booted, but it does not like to lie down on a bed and be blown upon by arctic air. Only those who are clearing what we might call ‘false heat’ like it. As you say the body cannot relax because it is no longer feeling supported in its natural warm and fiery state. We know so well how beautiful it is to be held, to be living in a loving ambience.

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