Monday, December 21, 2015

And Now for Something Much More Serious

I have started this post several times, and can't seem to select the appropriate wording.

Last week, a close family member died from breast cancer.  She made it just slightly longer than two years from her date of diagnosis.  She was young.  She had young children.  She had the BRCA1 genetic mutation (yes, the same one made popular in recent media by Angelina Jolie).

Many other women in my family also have this genetic mutation.  My own mother survived breast cancer at a very young age, and has gone on to survive two recurrences in recent years.

As you might imagine, I have been incredibly frightened of breast cancer for most of my adult life.  It is only during the past year that I have found the courage to do anything to take charge of my own breast health.

I am writing this post with the hope that at least someone who reads it will understand that fear and inaction are not the way to manage your breast cancer risk.

1.  Do your breast self-exams.  
Don't lie about it, don't put it off, don't worry about what you might feel or find.  JUST DO IT.  You can't overdo breast self-exams.  They are easier in the shower, when you are slippery and covered in soap.  Get familiar with the texture of your breasts and the way your ribs feel underneath them.  And if you find something, either call your PCP and leave a message asking to speak to a nurse, or (if you have no PCP), go to a Planned Parenthood clinic.  You can walk in, and just ask for a breast exam follow up.  DO NOT DELAY. 

2.  Ask for breast exams during your routine physicals.
Your OB/GYN should be doing these exams during your annual wellness visit.  But, you may not be visiting a women's healthcare provider annually, for a variety of reasons.  Any doctor or nurse can do this exam, during a routine physical or any other visit.  Just ask.

3.  Ask your female relatives about their breast cancer history.
Many women, those from older generations especially, keep this information private.  Make it a point to ask your mother, aunts, sisters, and female first cousins about their breast health.  Ask about their age of diagnosis, the specific diagnosis, and treatment outcomes.  Make notes.  Share everything with your PCP during a routine visit, and ask that it be added to your chart. 

4.  Know that you may need a mammogram earlier than you think.
There are new guidelines for mammography for women with specific breast cancer risk factors.  For some women with elevated risk, the recommendation is to start annual mammograms at age 35.  I had my first mammogram last year, at age 35, based on guidelines from my health insurance provider.  At the time, my only risk factor was my mother's past diagnoses.

5.  Do not be scared of a mammogram.
I have no idea why people say that mammograms are painful or even uncomfortable, unless they are particularly upset by having their breasts exposed or touched.  My experience was painless and stress free.  During a routine physical, my doctor wrote me a referral for a mammogram.  I called a diagnostic imaging center at a nearby hospital and made an appointment for the very next week.  I took my doctor's information along, so he could be sent the results.  I sat with other women, filled out paperwork, and watched an instructional video.  We were taken to a special locker room to undress from the waist up, clean our arms and chests with antibacterial wipes, and dress in special gowns.  The radiologist showed me how the machine worked, gave me instructions for how to stand, and took four images.  The whole thing took less than 10 minutes.  The machine sort of smooshes your boobs down, which feels weird, but didn't hurt me at all.

6.  Find out if genetic testing is right for you.
After speaking with my doctor, we decided that the benefits of genetic testing for me would far outweigh any of the harms (stress, worry, cost, potentially not being able to act on results right away, etc.).  In the end, we decided to use the Myriad test, but there are literally hundred of different ones to choose from.  Myriad is a kit your doctor orders, then sends back in with a single vial of blood.  We knew that at least half of the cost of the test would be covered by my insurance, and Myriad has a flat out-of-pocket cost guarantee for anything your insurance doesn't cover.  In the end, I paid about $200 for full genetic testing.  Look around, call your insurance, and know what is covered.

Just two months ago, the American Cancer Society released new recommendations for breast cancer screening, and state and federal law changed to follow suit.  That link provides all the information you need to find free or affordable screening.  It also explains how things work for Medicare, Medicaid, and self-funded plans.

7.  Don't stress or put things off.
Knowing bad news today is a million times better than being surprised by tragedy in the future.  It is better to be labeled a hypochondriac or worrywart than to go to your death wishing you had complained earlier.

I apologize for such a wordy and somber post, and I promise I will be back to regularly scheduled programming shortly.  But I truly feel that every woman needs to understand what I have written in this post.  Take care of yourselves. 

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