Get a Better Mammogram: A Smart Woman’s Guide to a More Understandable—And More Comfortable—Mammogram Experience

PART I

THE BASICS

CHAPTER ONE

Meet the Cast

There are a few people you will encounter during your mammogram experience. Let me introduce you to some of the main characters.

YOU, THE PATIENT

You are the center of this process. You are allowed to ask questions about your care and your exam and to receive the results of your mammogram in words you can clearly understand. You know the answers to important questions about your health history and your family history. You will be asked how old you were when you started your periods, the years your children were born, and whether you breastfed or bottle-fed. You will be expected to remember where your last mammogram was performed, along with the dates of any breast surgeries, and if or when you have taken hormonal medication or ever smoked cigarettes.

This is a lot to remember. It is a good idea to have this information written down for quick reference. This can save you a good ten minutes of calculating time when your mammography technologist records your health history.

THE SCHEDULER

You will probably be scheduling your mammogram over the phone. If you are over forty and only need a yearly screening mammogram, you will not need a doctor’s order for your appointment. You will need a doctor’s order if you are experiencing any new symptoms in the breasts or if you have been instructed to have a follow-up diagnostic mammogram based on your last mammogram.

The scheduler will instruct you to not wear any powder, lotion, perfume, or deodorant on the day of your appointment because anything on the skin’s surface can interfere with clear images.

THE REGISTRATION DESK

When you arrive for your appointment, someone at the desk will gather information about your doctor, your insurance, and the type of appointment you are having. Though some of the registration staff are fairly savvy about patient insurance, it is important to call your insurance provider ahead of time if you have questions about what is and is not covered.

THE RUNNER

Many breast care centers have helpers to walk you from the general waiting area to the mammography waiting room before your exam. You will be greeted, shown to your locker and a private dressing area, and given a gown to change into for your exam. You will probably be reminded to remove any deodorant or powder if necessary. The dressing areas have moist, prepackaged wipes for this purpose and usually deodorant for applying after your exam.

Once changed, you will wait for your mammography technologist, the person you will interact with for most of your mammogram.

YOUR MAMMOGRAPHY TECHNOLOGIST

Your mammography technologist will come to the waiting room and call your name. She will walk you to the exam room, confirm your name and birth date, update your phone number, and confirm the names of the doctor(s) you choose to receive your mammogram results. If you are new to the facility and have not brought your images from the last place you had your mammogram, she will have you fill out a form so they can be requested. The mammography technologist will answer any questions you have about the mammogram itself, let you know when you will get results, and take the images.

YOUR ULTRASOUND TECHNOLOGIST

If you are having a diagnostic mammogram, ultrasound imaging is routinely, but not always, used to complement the mammogram images. After the radiologist has read the mammography images, the ultrasound technologist will walk you to a separate room for the ultrasound portion of the exam.

THE RADIOLOGIST

The radiologist, a medical doctor who specializes in reading medical images of all modalities (mammograms, ultrasound images, MRI, and bone density scans, to name a few), has recommended which mammogram images are needed to clearly see an area of concern in your breast tissue and has read the required images, along with any ultrasound images that were recommended.

If an ultrasound follows your diagnostic mammogram, the radiologist will usually come into the ultrasound room to see the images herself before giving you the results of what she sees in your breast tissue. After the radiologist has gathered and read all the images, she will typically meet with you and your mammography or ultrasound technologist to discuss your results and answer your questions.

NURSES

You will meet a nurse if you are scheduled for any type of breast procedure that goes beyond a diagnostic exam, such as a biopsy to sample the breast tissue. She will explain your procedure and your healing process and will carefully document any medications you are taking. It is helpful to bring a list of your medications with the dosages when speaking to a nurse. Biopsy results will usually require you to meet a nurse in person.

If a biopsy results in a breast cancer finding, nurse navigators become involved. Navigators are specialized nurses who help patients transition from hearing the difficult news of a breast cancer diagnosis into the process of cancer treatment, explaining each phase of the journey.

CHAPTER TWO

Today I’m a Patient

In an hour, I will get in the car and make my way to the breast center, not as a technologist but as a patient who got called back for additional images after a screening mammogram. I will walk into that waiting room this morning with some understanding of this diagnostic process. I know what comes next when I get a call for additional images.

Knowing the steps in the process isn’t as good as a guaranteed healthy outcome, but it is so much better than going into that building with absolutely no idea of what will happen over the next two hours as I am asked to forsake my comfortable clothing and don the robe that transforms me from technologist to patient.

I know how the room will look and how the machine will hum slightly as the technologist asks me a few questions. I know which plastic compression paddles will be used, how long that compression will last, which angle of the machine will be used, and how I will be placed alongside it.

I know the mammography technologist—how many dogs she has, what her husband’s name is, and where she gets her hair done. I know the radiologist—how old her boys are and where she went on vacation this year. All of these things make me feel a little more at ease. I’m grateful for that. But there’s one thing I don’t know.

Once the suspicious area in my left breast, what looks like a new cyst, is compressed and those images are carefully read, I will be sent to receive an ultrasound. The radiologist will come into the ultrasound room to see the live images, and I will hear the verdict:

• Healthy or unhealthy

• Normal or abnormal

• Benign or suspicious

• See ya next year! or We should get a biopsy of that area.

Wish me well today, sisters. When I put on my uniform and walk through those same glass doors tomorrow morning as a technologist, standing on the other side of that big white machine, I will most certainly be wishing the same for you.

CHAPTER THREE

Island Gorillas and Other Fears

Mammograms can make us feel a little vulnerable. Thanks to the Pap smear and—oh, goodness—the colonoscopy, the mammogram is not the most unpleasant exam we have to go through. Still there is a certain awkwardness involved when we have to take off warm clothing, put on thinner, less-attractive clothing, and expose our breasts to a stranger, who is then going to place them on a not-so-warm surface and press them out like biscuit dough while we hold our breath. Just relax is not something we want to hear at that moment.

All of us experience differing degrees of awkwardness during our mammograms. Though many of us are fairly at ease with the process, nervous tension or a past negative experience, clinical or otherwise, can give us a vague sense of something being done to us.

When anxiety or a bad memory follows us into the room, that mammogram can be much more awkward for us, even though we know it is necessary for our breast health and we understand with our logical brain that the mammography technologist placing our breast in that cold machine is simply performing a routine exam.

For some of us, when we enter that exam room and see that tall, gleaming machine, we feel a little like some poor woman in a low-budget movie about to be sacrificed to the Island Gorilla. We have already had to exchange our normal clothing for the ritual gown (the pink kimono) required for the sacrifice. The Gorilla Priestess (the mammography technologist) asking all the questions is only there to calm us down a little before we are led to the ritual altar (the mammography machine). It can all feel a little mysterious and more than a little rattling if we do not know what is coming.

As one of those Gorilla Priestesses (a mammography technologist) I want to offer you a cup of strengthening potion, that is, information. Knowing what is coming is a comfort like no other and reveals the sacrificial altar to be just a mammogram machine that takes some pictures and reveals the fact that there is no giant Island Gorilla, just a radiologist down the hall who will be reading our pictures and communicating our results to us.

As a patient, my mammogram experience is riddled with some of these emotional reactions, even though I understand every aspect of that tall machine, specifically how it works, how best to position my body, and how long I will be holding my breath. For me, there is a sense of vulnerability in opening that gown and having another human being, perhaps a total stranger, place my breasts against that cold metal and plastic surface.

My logic succeeds in getting me through the exam calmly and successfully, but at some level I can hear the tribal drums thumping. Where is that Gorilla Priestess? Can I get some mango juice before the big sacrifice … with one of those cute little umbrellas? That would be nice.

It is very human to feel protective about our bodies. Taking our clothes off for an exam, even from the waist up, feels uncomfortable for some of us. Patients often communicate their feelings of awkwardness verbally:

• Well, I used to be a lot more modest before I went through childbirth.

• I just hate that it always feels so much colder in this room.

Some women lighten the moment with humor:

• I told my daughter you were going to squish me like a pancake.

• A man obviously invented this machine.

Out of modesty, some women get as close to the machine as possible, hoping very little touch will be involved if they help the mammography technologist in the positioning process. Others attempt to retain their modesty by only removing a small window of the breast from the gown, keeping as much skin covered as possible, not realizing that the margins of the gown are still in the way and they are going to have to bring the entire breast and shoulder out for positioning.

I see a natural reasoning process taking place. We verbalize our discomfort through humor or attempt to help as a means of coping with our awkwardness. We may balk at the oddness of having a stranger see our nakedness, even if she is a woman and is mercifully wearing exam gloves that make her hands not quite so cold.

For women who have experienced breast cancer, encountered situations in which they were victimized, or have mental disabilities that profoundly limit their understanding of the exam process, the mammogram can be a very unsettling experience, triggering feelings of irritation, helplessness, or confusion. A woman who has survived breast cancer may experience a powerful surge of emotions when she sees a mammogram machine. Whether it is recorded in her medical record or not, a woman sometimes walks into the exam room with memories that are as ugly as cancer. She does her best to ignore her feelings even as she allows her technologist to draw her body toward the machine, all the more so as she holds her breath for the images.

I often hear a woman’s story as the exam unfolds. As I maintain eye contact and give her the necessary time to adjust to the process of the mammogram, inside I am praying for strength and peace for her and that I will be quick and skillful. I am hoping above all that nothing will be found on her images to complicate her life any further.

It is very important for patients to communicate to the technologist if they begin to feel overwhelmed by the mammogram process or if they need a little extra time between exposures to breathe, to take a drink of water, or to regain the mind-set needed to feel they are in control of the exam, not the other way around.

This is a perfectly reasonable request. No mammography technologist worth her salt will object to taking a few extra minutes and allowing her patient to prepare herself when it equates to a less stressful exam for the patient. We do the same to accommodate any physical barriers, for instance, wheelchair-bound patients and persons with limited range of shoulder motion or paralysis on one side. Why would we not make allowances for any psychological limitations since they are just as restricting as the physical kind?

It is important, as far as possible, to be an engaged participant during your mammogram. Communicating your feelings about the exam, giving only the details you feel comfortable providing, and letting your mammography technologist know what you need can ease some of the physical barriers, such as shortness of breath or muscle tension, that could add to your discomfort as well as compromise the quality of your images. Involuntary muscle tension that makes positioning difficult or inability to remain perfectly still can be documented, just as it is for patients with frozen shoulder joints or Parkinson’s disease.

Communicating what you are feeling can help your technologist customize the exam for your comfort and obtain the best images in future visits. There can be real physical symptoms that echo emotional and psychological ones, and these can be noted so the radiologist understands that the patient and technologist obtained the best possible images that day, given the limitations (Peart 2018).

The worst possible response to the discomfort of a mammogram, compounded by the scars of past victimization or abuse, is avoiding the mammogram or other health screening