Have You Had a Mammogram Yet? You Should.

During Women’s History Month, we focus on a wide array of issues particular to women including equal pay, equal opportunities, and access to health care. Although being able to get the care we need when something goes wrong is vitally important, it is just as necessary that women seek and take advantage of the various screenings commonly recommended and available to us, in order to detect possible problems while they are at their most easily treatable stages.

The Centers for Disease Control (CDC) recommends that women who are 50-74 years old and of average risk for breast cancer go for a mammogram every two years. A mammogram is an x-ray of the breasts and is the best tool currently available for early detection of breast cancer, which affects approximately 264,000 women and 2,400 men in the United States each year. According to the CDC, about 42,000 women and 500 men die from this cancer every year and black women are especially vulnerable, dying at a higher rate than white women. The American Cancer Society estimates that more than 8,500 women in New Jersey have been newly diagnosed in 2023 alone. New Jersey has the eleventh-highest rate of breast cancer (in women) in the United States.

Mammography cannot prevent cancer but it can help to detect it early, allowing for the best possible outcome. When found early and when cancer cells are localized to the breast itself, the five-year survival rate is nearly 100%. That means that almost all women diagnosed at an early stage and whose cancer has not spread to any other part of the body have an extremely high probability of still being alive at least five years after their initial diagnosis, relative to women who do not have breast cancer.

In 2020, the most recent year reported by the state, approximately 80% of NJ women between the ages of 50 and 74 had a mammogram. White women had the lowest incidence of receiving this screening, with black, Hispanic, and Asian women all coming in at over 82%.

Why don’t more women get this potentially life-saving screening? One reason may be lack of health insurance and the cost of the procedure. If this is holding you or someone you love back, see THIS LIST of locations in New Jersey offering low-cost or free mammography. Some women may be scared of the process or of the potential to receive unsettling or scary news. While that is a legitimate fear, this is a case of “what I don’t know won’t hurt me” being wholly untrue.

When I was a new mother in my mid-thirties, I had a concerning issue that sent me first to my Ob/Gyn and then, at their recommendation, to a radiology center for my first-ever mammogram. That initial screening resulted in a referral to a breast surgeon for a consultation and her testing revealed some “atypical cells”. I remember driving home from that appointment and crying, worrying about what could be going on and if I was going to be around to see my little boy grow up. Uncertainty can lead to worst-case-scenario thinking. Thankfully, further testing found no evidence of cancer but coupled with my family history and Ashkenazi Jewish heritage, I was deemed at higher-than-average risk and since then, I have been screened annually to ensure that if anything developed, it would be caught early. Over the course of the past fifteen years I have also had ductography and two MRIs to get a better look.

Today I went for my annual screening at a dedicated breast health center and, in the hopes of encouraging even one more person to make their own appointment, I am sharing my experience. Every screening center will look different and be run a little differently, but this is generally what you can expect. I was told not to wear deodorant, powder, or perfume on the day of my screening because the residue will show up as spots on the x-ray, making the images harder to interpret. I was brought into a waiting room reserved solely for other women having their own screenings and given a robe to change into after removing everything from the waist up. There was calming spa music playing and light snacks available while we waited to be called for the next stage. In the actual mammography room, a technician greeted me and led me over to the large machine.

The process is simple and mercifully quick but uncomfortable. How uncomfortable the procedure is depends on each individual, the size of their breasts, and whether or not they are already tender due to hormonal fluctuations. It is recommended that you not schedule a mammogram too close to your menstruation date if you tend to be extra sensitive then. The technician asked me to step up to the machine and remove my right arm from the robe and she then placed my right breast on a flat plate (the black surface in the photo) and gently pressed it flat with her hand. She then helped me to position my body correctly as she lowered a large plastic plate down to press the breast flat. This is the part that is definitely unpleasant and even a bit painful. The technician has to tighten the plate enough so that the breast does not move even a little. If it does, the resulting image will be blurry and the procedure will need to be repeated. Once positioned correctly, the technician stepped behind a barrier, told me to hold my breath, and took an image. This part took less than 30 seconds. She then repositioned the upper and lower plates to capture a side view, repeated the flattening and squeezing, then stepped back and took a second image. The entire process was repeated on my left side and I was done.

After a short wait in a different waiting room, I was brought into another room where a nurse performed a manual exam. She asked me some questions, had me raise my hands over my head, and then felt for lumps or other irregularities as I laid back on a table. After the short exam, I was led back to the changing area and went home to await my results.

Early detection saves lives. People with breasts should check their own regularly so that you know what they typically feel like and may therefore notice if there is a change. Note that there might be perfectly normal changes to the breasts during certain stages of a menstrual cycle and that certain sicknesses - or even a recent vaccination - can inflame the glands under the armpit. The Mayo Clinic recommends that you contact your doctor if you notice any of these symptoms:

• A hard lump or knot near your underarm
• Changes in the way your breasts look or feel, including thickening or prominent fullness that is different from the surrounding tissue
• Dimples, puckers, bulges, or ridges on the skin of your breast
• A recent change in a nipple to become pushed in (inverted) instead of sticking out
• Redness, warmth, swelling, or pain
• Itching, scales, sores, or rashes
• Bloody nipple discharge

Barbara Levi James understands the importance of early detection all too well. In 2018 she nearly rescheduled her annual screening when the facility was running late and she was concerned about missing her exercise class. Instead, she waited, got the mammogram, and two weeks later found herself being called in for further testing. Following an ultrasound, which you are entitled to request if you have dense breast tissue, and later a biopsy, James received news that nobody is ever quite prepared for. It was cancer.

James had surgery for the tumor, which was small and localized, four rounds of chemotherapy, and 20 of radiation. She was then declared cancer free and was started on a daily estrogen-blocking pill (aromatase inhibitor) which has been shown in clinical trials to greatly reduce the possibility of a recurrence. James had no known risk factors; her cancer, like so many other women's (and men's), was a complete surprise. “I'm glad I went for annual mammograms because without them, I might not be here today to write about my experience. As a survivor, I am glad to answer any questions and support you.”

Micki Audette-Gaudet, also a survivor of breast cancer, has a different story. Audette-Gaudet had been dreaming that her sister, who died after a long battle with this cancer, was urging her to get a mammogram. She did, but the screening showed nothing. Thanks to her persistence and a doctor who listened to her concerns, she was screened again in six months with another mammogram and an ultrasound. This time, the diagnosis was aggressive ductal carcinoma in situ. Cancer. Because of her family history, Audette-Gaudet opted for a double mastectomy. All of the cancer was removed and she didn't need chemotherapy or radiation.

If you would like to contact Barbara Levi James to discuss her experience or to ask her questions, you can contact her by phone at 973-454-3243 or via email at cybermommylja@cs.com. Micki Audette-Gaudet is also happy to be a resource. You can reach her by phone at 201-398-3849 or via email at mbgaudet2014@gmail.com. You can also visit the National Breast Cancer Foundation, Inc. for additional resources and more information.

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