Mammograms: The thick and the thin of it 

By Norah Wilson

By the time you read this, I will have turned 44, yet I've never had a mammogram. Having had the procedure described to me in hilarious detail (Hilarious for me, that is!) by a friend, I must say I'm not anxious to experience it myself. On the other hand, every woman is supposed to have a baseline mammogram at age 40, right? Which means I'm overdue. And being a taxpayer in a country with a publicly funded health system that invests heavily in prevention, I could see no excuse for putting it off. So on my last visit to my family doctor in October (which just happens to be Breast Cancer Awareness Month), I raised the issue with him. His response? "Well, if you want one, I can schedule it, but frankly, unless you think you have a breast issue, you don't really need a mammogram until you hit 50."

Huh? When did that change?

As it turns out, it's not really much of a change. Breast screening programs in most of the countries I researched target women between the ages of 50 and 69, who are at the highest risk of developing breast cancer. Organized breast cancer screening typically involves the aforementioned mammogram (breast X-ray), a clinical breast examination by a health professional, and instruction on breast self-examination. Women in the target age group can usually access such programs for free and without a physician's referral. As long as there is no sign of breast cancer on the first screening, most programs prescribe further screening at two- to three-year intervals.

So why did I think I needed a mammogram by age 40? And why did I think I needed it annually? Possibly because that's precisely what the American Cancer Society's cancer detection guidelines recommend. They suggest that for women with average risk, they should be having yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. They caution that women at increased risk, e.g., family history or previous breast cancer, should speak to their doctors about starting mammography screening earlier, having additional imaging tests, or having more frequent clinical breast exams.

So who's right about this mammography thing? After poring over a tremendous amount of literature, I'm still not clear on the issue. I take comfort in the fact that a tremendous number of physicians find themselves in the same state of uncertainty. It seems that about the only thing there is universal agreement on is that mammograms are of very limited value in women under 40. Younger breasts are more glandular/dense and less fatty than older breasts, making it impossible to spot small tumors effectively with this technology. Fortunately, younger breasts are much less likely to develop cancer, age being the single biggest risk factor.

In my search for clarity on this issue, I unearthed a 2002 article from the June ACP-ASIM (American College of Physicians-American Society of Internal Medicine) Observer about the pros and cons of screening for three cancers, of which breast cancer was one. The article suggests that women have been oversold on the benefits of breast cancer screening without being informed about its limitations (e.g., subjectivity of reading mammograms) and potential risks (e.g., exposure to radiation, discomfort, aggressive overtreatment for particular types of carcinomas that may never develop into aggressive malignancies, economic impact, etc.). I will leave you with this quote from that article, which reinforced my belief that I'm not "overdue" for my mammogram.

Dr. Elmore, head of general medicine at Harborview Medical Center in Seattle and associate professor of medicine at the University of Washington School of Medicine, pointed out that most physicians still agree that mammograms help save lives. "We think that the data show that women over age 50 should be screened every one to two years with mammography and clinical exam," she said. "We think this can reduce breast cancer mortality by 20 percent to 30 percent."


Norah Wilson works for a provincial health care association in New Brunswick, Canada. While she does concern herself with health policy, she is not a clinician. She believes women should educate themselves on the issue of breast health, as with all health issues, and make their own decisions in collaboration with their health care providers.

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by Dr. Debra Holland

At this time of year, magazines start running articles on dealing with holiday stress, a very worthwhile topic. These articles discuss simplifying the holidays and doing as much planning and work in advance - both useful for managing holiday stress. But this column is not going to be like the traditional ones you read in December.

I had an experience recently that prompted me to write this article, using my own situation as a teaching tool for stress management, both during the holiday time and throughout the rest of the year.

On my way to a consulting job in Hollywood, I received a call asking why I wasn't at the seminar I thought I was going to be teaching the NEXT week. Fifty people had been waiting for me for 20 minutes, and the manager was IRATE!

Guess what my topic was? Stress Management.

I was horrified! I couldn't believe I'd mixed up the date. I was also ashamed. It's not like me to make mistakes like this, and I hadn't even studied the material I'd be presenting for four hours. Shaken, on the verge of tears, I called to cancel the Hollywood job. Luckily there were others there who could take my place. I turned around and headed home to pick up the PowerPoint program and the training and student manuals.

I called the irate manager (who by then had calmed down a bit) and profusely apologized. I told him I'd be there in about 45 minutes. I was a little relieved to learn they could move a part of their program that was supposed to come after my talk into the morning. The audience members weren't twiddling their thumbs waiting for me to show up.

I was also upset because this was only the second job I'd done for this consulting company, and I figured I'd just blown the opportunity for future work.

On the race back to my house and then to the site, I knew I'd have to apply all the stress-reduction techniques I was scheduled to teach my students or I'd arrive at the hotel a frazzled mess and lose any credibility I had left. Plus, I knew I'd potentially alienated everyone who'd be listening to me, and I'd have a lot of ground to regain - not something I'd be able to do if I was anxious and stressed.

Here's what I did to decrease my stress level:

1. I began to take deep, centering breaths. Centering breaths are when you breathe to the bottom of your lungs, pushing your belly out when you inhale, and pulling your belly in when you inhale.

2. I prayed. I knew I needed all the help I could get, so I asked for divine guidance for this situation to turn out in a positive manner.

3. I began to list what I had control over and what I didn't have control of.

I didn't:
* Have control over going back in time and fixing my mistake.
* Have control over the traffic.
* Have control over what was happening at the hotel, and what the people involved currently were feeling or thinking about me.
* Have control over the fact that I hadn't even glanced at the materials.

I did:
* Have control over my attitude - negative or positive thoughts.
* Have control over my body - taking deep breaths.
* Have control over remaining panicked or preparing myself to teach a class by deciding what to do, how I could use what I already knew about the topic along with what was in the actual program from my consulting company.

4. I focused on letting go of the circumstances I didn't have control over and concentrated on what I did have control over.

Letting go meant not dwelling on them and especially not magnifying the negative situation by building up more fearful fantasies in my mind.

By doing these four steps, I became more (although not completely) relaxed, and my mind started working on creative solutions. I was able to gear up my energy, knowing I had to go in and give the best teaching performance of my life. So when I arrived at the hotel, an hour and 15 minutes after I was supposed to have started my presentation, I was ready to hit my mark.

And I did.

What followed was an amazing experience, one that taught me more than I taught my class. I walked in, apologized publicly to the audience, and used my own example - what happened, all my reactions, and how I handled them - as the opening to the class. They were laughing and relating, and in five minutes, I knew I had them hooked. Even the manager (who'd greeted me politely, but had silently made it clear that he was mad) relaxed his stiff body language and joined in the laughter.

So I relaxed, too. I put the negative experience behind me and rode the wave of laughter into a positive, energy-filled presentation. I was able to navigate through the material, maybe not the way I would have if I'd been prepared, but in a way that still worked. And we ended up having fun. They were a close-knit group with a sarcastic sense of humor, and that helped. We laughed a lot.

At the end, when we were discussing how to learn from our mistakes, I again used myself as an example. "One," I said, "was that I'd learned to triple-check future speaking engagement dates. But two was that I have learned I can make a spectacular mistake, be VERY upset about it, yet meet the challenge and turn it around. How valuable is that to know about myself?" As I was speaking, I could feel the positive boost I'd given to my self-esteem. And I laughed and told the class, "I'll have to fill out an evaluation form for myself."

The class evaluations came back very positive, and my consulting company was very pleased.

What a lesson. (One I'd prefer not to have to learn again.) I'd stepped up to a challenge and mastered it. If I'd given up and avoided the situation, this experience would be forever branded in my consciousness as a shameful failure. But instead, I have a positive experience that I can always use to motivate myself when I'm confronted with a new challenge.

So, as the holidays approach and you're dealing with challenging situations, remember to take deep breaths, pray, decide what you have control over and what you don't, then release the anxiety about what you have no control over. Focus on the positive - especially love and gratitude for all the wonderful people and things you have in your life.

I hope your holidays are relaxed, filled with special family and friends, laughter, love, and joy.


Dr. Debra


Debra Holland, Ph.D., is a licensed psychotherapist who specializes in relationships and communication techniques. You may visit her website at www.drdebraholland.com. E-mail her your questions at drdebra@drdebraholland.com.

To read last month's Living Well article, click here.

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