The beauty of unenhanced breasts
The reminder to have the second follow-up flashed on my PDA regularly starting in September, but I kept stylusing it to "snooze" until two weeks ago. Likewise, last fall, I ignored the two notices that told me that I was overdue for my annual mammogram (it was supposed to be in October) and needed to schedule it immediately.
Then, as part of my new year's resolution to do what's on my to do list (and to actually keep a to do list that's accurate, complete and in small enough chunks so that I can complete items on it) instead of just keeping the list and thinking that that's enough, I scheduled the MRI.
The recap is that I have a very strong family history but a just-too low Gail score (this tool gives a similar result for me, so I would guess it's quite accurate) that makes me ineligible for many clinical trials related to prevention. Genetic testing showed that my mother (who was diagnosed with breast cancer at age 44; her mother died at age 52 of metastasized breast cancer) does not carry the BRCA-1 or BRCA-2 mutations, but, in 1999, I was given about a 30% chance of getting breast cancer. (According to the American Cancer Society, "The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 35." You can read the most recent ACS report on breast cancer, for 2007-2008 here.) Given my increase in age, I would expect that my risk has gone up somewhat, though probably not enormously.
So at age 43, it was suggested that I start to get MRIs annually (I already see my ob/gyn once a year for my annual, and a breast cancer specialist six months after that, each year; that's been going on since I turned 40). Again, because of my family history (in addition to my mother and her mother, there's also my mother's father's sister, her daughter and her granddaughter; they all had cancer and two of them died of it; two had breast, one had bone).
My first MRI showed what they call "enhancements" which mean that there were "hotspots" that they want to look at further. So I went for spot compression mammograms (don't those sound fun?) and ultrasounds. None of those follow-ups showed anything, which is kind of bad - because it means that they don't really know if there's a problem. Hence, the first follow-up MRI. That MRI showed that the hotspots were no longer there, but I had new hotspots. Hence, the second follow-up.
That was this morning. During the MRI, which lasts about 23 minutes, you are not supposed to move and should only barely breathe while the "push" and the contrast fluid cycle in and out.
I'd been shown what the enhancements look like on my records before. They are highly colored areas in some screens and big fluffy masses in other views. The images can be manipulated to be three-D and turned around and head-on and sideways and, to someone who doesn't know science, it's an amazing thing.
This morning, I got to see absolutely through my breasts. No enhancements, no fluffy clouds, nothing. The doctor was elated. She said that this was what she was hoping for and she was convinced that the prior two MRIs were most likely due to hormonal shifts. Timing is everything - or at least, it's extremely important in pre-menopausal women who get MRIs.
The result? I don't have to go back in for a year. I had my annual mammogram done as well this morning but she's expecting that that will confirm the MRI, though yes, each of those tests can find things that the other won't.
As I've written before, this negative result thrills me to about 90%, but it leaves me with a bit of resignation that "it" might happen next time. I'm so convinced that I won't get through life without getting breast cancer that while I was inside the MRI tube, unable to move, a tear rolled down my cheek as I thought about what it would mean if everything was okay. It means that I will continue to be monitored regularly until everything isn't okay. And then I started to think how lucky I am that I can have these tests. And then I started to think about how many women can't have or don't get these tests for a panoply of reasons. And sure enough, while I was waiting to get my mammogram, a woman nearly walked out without getting her testing done because she needed to get to her job. And then there's the parking and the health coverage.
All this is one reason why many people fight to have laws include mandatory coverage not just for the tests, but for help if there's a positive diagnosis. What good is the testing if you discover you have breast cancer but can't afford to be treated?
I'm not yet a crusader for all the things that deserve a crusade. But I follow what the Northern Ohio Breast Cancer Coalition does.
Maybe if I just add "Crusade" to my to-do list...