Breast cancer awareness month is October.
I decided to take this opportunity to discuss the factors why some women do not get their mammograms done and subsequently present with cancerous lumps at a much later stage of the disease. I have found them and their family members to share guilt and shame regarding the very same reasons even after their cancer diagnoses, and that necessitates the need for conversations like these when we are doing preventative health checks.
Women from the ages of 40 years and above are invited to undergo breast screening; however, breast tissue being denser in younger women makes it harder to detect precancerous or cancerous changes in this age group and below. We recommend an ultrasound to assist with the information available about their breasts rather than suggest only a mammogram to improve the quality of these measures.
Screening means that no symptoms or signs are present to suggest the possibility of disease.
Unfortunately, younger women also present with breast cancer, so it’s imperative to understand the risk factors and discuss ways in which they can be appropriately managed and seek review in a timely manner if they notice any signs or symptoms.
Pain experienced while undergoing mammograms is a huge concern for women who do not wish to attend their screening. Most of the time, the concern about the patients’ health can come across as authoritative by clinicians and healthcare staff, and although it comes from a place of care, it doesn’t usually help them agree to go ahead with the screening.
My suggestion to my fellow clinicians and healthcare staff is to try and spend time with those women to understand their reasons and concerns. These women are often not strangers to pain, so focussing on just the pain aspect of the mammogram is not very helpful, although of course it does need to be discussed.
Exploring their beliefs about the mammogram, the procedure, their understanding, their expectations and their concerns would be the main goal, and done in a compassionate and non-judgmental manner.
In my experience, most of the time when they have been heard in a safe manner, they are a lot more amenable to changing their mind or reconsidering their decision.
Informed consent and explanation about the risks and consequences done in a manner where it doesn’t come across as punitive or invalidating is imperative.
The National Breast Cancer Foundation has several information sheets explaining the anatomy, terminology of conditions and explanation of the signs and symptoms along with investigations and management options.
