At 45, Caught Between Mammograms

BOSTON — I got a mammogram last week.

The tech person, a lovely Russian woman from Brooklyn, said she thought everything looked fine. Then, a few days later, a nurse called to say there appeared to be a tiny calcification in one breast. “Fairly common,” she said. “I wouldn’t worry too much.” She scheduled me for more imaging. This Thursday, at Mt. Auburn Hospital.

It was my first mammogram in about eight years, since the birth of my two children.

There is no breast cancer in my family history, so I was pretty lax about getting screened again. But my primary care doctor in Cambridge kept telling me to do it, citing the previous guidelines to get a mammogram annually after age 40. I am 45.

Rachel Zimmerman (Julienne Schaer)

But during the years I nursed my daughters, I kept delaying the screening. Finally, when it was clear that my breastfeeding days were over, I scheduled the test (which, for those of you who haven’t had it, is really annoying, and involves stretching and flattening your breasts over a hard surface and then squeezing them down so they sit like sandwich meat between bread.)

Last night, after reading Gina Kolata’s story in The New York Times about the new guidelines that urge women to wait until they’re 50 before getting routine mammograms, I feel like canceling my appointment.

But of course, there is the issue of the small, “fairly common,” calcification. While I am healthy, excercise regularly, don’t smoke and eat well, you never know, right?

A good friend, a 39-year-old vegetarian marathon runner, died suddenly a few years ago, due to a rare heart condition, leaving two young daughters. Another healthy friend, whose mother died of breast cancer, got a radical mastectomy and hysterectomy after learning she had the gene for breast cancer. How can I, a journalist, a mother, a curious human being, not find out what is there in my body, guidelines, or not?

Today, I kept thinking about how, despite our knowledge about science and probability, we expect medicine to be so clear, to give us straight answers and immutable guidelines. I read all the coverage on the debate, trying to better understand what to do. I talked to my mother, my husband and my women friends. They were also confused. But here I am, between two mammograms, wanting reassurance and clarity, but also understanding that it would probably be OK to wait.

Or would it?’

A post-script: I just got back from my follow-up mammogram. Everything is normal. The “calcification” they saw on the initial image turned out to be overlapping tissue. Still, the changing room was plastered with black and red signs announcing Mt. Auburn’s position on the new recommendations. The hospital, siding with the American Cancer Society, is sticking with the old guidelines — routine mammograms annually for women starting at age 40. As I left the imaging center, the technician who delivered the good news waved to me and said, “See you next year.”

Rachel Zimmerman curates WBUR’s CommonHealth blog. She worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau.