Knowing Your Boobs Could Save Your Life

On Tuesday, the American Cancer Society published new Breast Cancer Screening guidelines reducing the recommended frequency of mammograms for women over 54 to every 2 years and increasing the age for a first mammogram to 45 for women with an average risk of breast cancer.  They also kicked the clinical breast exam to the curb.  How much can a physician know about my boobs and my “normal” by feeling them once a year?  Now me, I can touch them every day if I want, and I certainly see them during my daily ritual.   Early diagnosis is key to beating breast cancer and many are triggered by women who notice a change in the look or feel of their boobs.  Our breasts feel differently in each decade.  Natural changes occur, especially as we bear children and get older.  Tiny, swollen, lumpy, I know intimately the phases my boobs passed through to land happily at soft tissue.  I know what my skin looks like, where there are stretch marks from pregnancy, and the color of my areola, however I need to use the mirror more often with arms raised.  Rashes, dimpling, or swelling also occurs in the breast tissue on our sides, and is more likely to go unnoticed.Breast Exam

The American Cancer Society is careful in its language, stating a woman should have the choice at 40 to request a screening mammogram and become educated on mammography limitations.  Women at high risk (20-25% lifetime risk) should begin annual screenings at 30.  They recommend breast MRI in conjunction with mammography for women at high risk because the two detect different types of cancer, so if I found a lump or had other breast cancer symptoms such as skin or nipple changes, my plan is to request both.  False positives are more likely with breast MRI, but despite the American Cancer Society’s concern about causing me ” a lot of worry and anxiety”, I prefer an unnecessary biopsy with a huge slice of peace of mind to later-stage cancer.  And despite a statement that self exams do not show a clear benefit, I trust my judgement on this one and will continue to feel myself up in the mirror on a regular basis because self-love is a beautiful thing and the new guidelines for breast cancer screening are not definitive, but leave the responsibility with me.

 

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Endometrial Ablation, An End to the Bloodbath

 

*Warning:  If discussions about menstruation and lady parts make you queasy, this post is not for you.

Since perimenopause set in eight years ago, I developed penis envy, not so much because I’d like one, but simply to eradicate several unpredictable and exquisitely painful periods per month.  Never prepared, no matter how many bloody tidal waves assailed my linens, my pants, my chairs, my life, I was taken off guard.   I am unaware of a more irritating interruption than a distinct gushing feeling in the middle of a meeting, especially when you are the one taking minutes.  Several times I prayed for a fire alarm.  When my red blood cell count fell to a level worthy of a gynecological consult, I felt relieved.  Dr. Burns, well into his 8th decade, said I seemed a good candidate for an endometrial ablation as long as fibroids did not lurk in my uterus.  Two tiny fibroids, one smack dab in the middle of my uterus and likely the painful trouble-maker, showed on ultrasound.  Fortunately, Dr. Burns has practiced for more than 40 years and was competent in more than one ablation procedure.  The simplest ablation procedure used a triangular mesh electrode that expanded in the uterus and delivered an electric current which cauterised and destroyed the uterine lining, and if needed, he had a back-up plan that used a roller-ball for the trouble-maker fibroid.

Elective surgery, while not typically as serious, entails risk and pain.  Infection is the scariest risk to me, likely due to a 3 month post-surgery infection following a previous gynecological mini-surgery.  I did not agree to an endometrial ablation sooner because of it.  Fear is a bitch, worthy of a post all its own.

Dr. Burns used the electrically charged mesh with success.  Prepping me with information, introductions, consent forms, and anesthesia took longer than the ablation, positively making me comfortable before asking Patrick to hurry up with the anesthesia in the operating theater.  Such a simple procedure to require such a dramatic environment, but…the risks.

My recovery nurse enjoyed my eyes-closed rendition of Gin and Juice and said I was her new favorite patient.  Apparently, I had my mind on my money.  Over the next few days I got to know the pain-killer norco as my uterus healed and I laid about on the couch drinking lots of liquids and eating toast.  So this is what it’s like in the 5th decade.  We endure procedures, therapy, and surgery to make life doable, and in this case, better than previous decades.  Little spots of blood every couple of months are all I have now.  Feminine hygiene companies are devastated by the decline in sales.