Everyone should have a pleasant mammogram experience

In In The News by Barbara Jacoby

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From: KevinMD.com

This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.  In my personal experience, mammograms have ranged from quite uncomfortable to downright painful.

And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in tears. Other times, the plates have dug into my ribs or my sides, or my skin has been pulled too tight in various directions. A few times, I needed to repeat a shot or two because I was told that the radiologist needed another picture because the first wasn’t compressed enough.

Last year when I went, I wanted to avoid the need for repeat pictures. The tech told me to let her know when I couldn’t take any more squeezing. So I just gritted my teeth and let her keep tightening. And she kept going. My breasts felt bruised and sore for weeks afterward. And one of the views needed to be repeated anyway.

So I really didn’t want to go today. But I did. Although there is some controversy as to the ideal timing between screening mammograms at different ages, my doctors recommend an annual schedule and from the studies I’ve seen, I agree that that’s a reasonable plan for me.

So I went to my appointment. And when I went into the room with the technician, I followed the advice I give my clients and that I’ve always given my patients. I talked. I voiced my concerns. And I was lucky to have a fantastic person taking care of me.

As she led me to the room, she spoke to one of the nurses about what room we were going to and where we would head afterward so that I would be seen efficiently. I commented on how she really had everything streamlined. When we entered the room, rather than keeping my mouth shut and worrying about being seen as “a complainer,” I told her about my past painful experiences, because I didn’t know how to get the appropriate level of squish without being injured (believe it or not, they don’t teach us that in medical school).

She told me that the re-takes that I had done in the past were likely not because of inadequate compression. She said that when the radiologist sees a little something that doesn’t look quite right, they get another picture to make sure, but so as not to alarm people they tend to say something that indicates the positioning or compression for the film wasn’t good enough, and on the repeat views they generally determine there’s nothing worrisome. She taught me that maximum compression doesn’t mean the best picture — there’s actually an ideal level that you can tell by the firmness of the skin on the compressed breast.

She performed the most comfortable set of breast x-rays I have ever had. And nothing needed to be repeated. And I wasn’t even cold, because instead of having me remove the gown completely, she pulled off one sleeve at a time and tucked the gown into my waistband so that most of me was covered and warm. Did I mention that this person was amazing?

None of this, by the way, was special treatment or “professional courtesy.” I never told her that I’m a doctor. We simply spoke to each other as we would want others to speak to us. I was honest. She was honest.

I have her card — and I’ll be sure to schedule next year’s appointment when she’s working. I also plan to relate my experience to the people who run the department. Everyone should have a mammography experience like the one I had today, every time. No need to freeze. No need to endure painful squeezing.

But someone does still need to work on a lighter adhesive for the nipple markers …

Abigail Schildcrout is founder, Practical Medical Insights, and blogs at DocThoughts.