It was a simple enough text message from my husband, who is holding down the fort at home in New York while I’m working in a public health fellowship in Washington, DC.
“Forgot to tell you, a nurse from Keller called. Said you are due for mammogram. Said you can call radiology directly to schedule.”
It makes perfect sense. I turned 40 in April and it’s December now, so the call shouldn’t come as a surprise. What is surprising, though, is that upon reading the text, I instantly fell apart and was consumed by my own sobs and tears. Why is there so much emotion wrapped up in the idea that it’s time for me to get a routine breast screening?
I think back to January of 2003, nearly 11 years ago. I was sitting on the exam table in the oh-so-flattering paper gown at my 6-week postpartum checkup with my OB/GYN at the Army hospital. My infant, who hardly slept the first three years of her life, snoozed in her car seat on the floor, allowing me to have a conversation with the doctor.
“There’s this lump here,” I showed her. “I think it’s a galactocele.” I wasn’t yet a lactation expert, but I had read up enough about breast abnormalities to realize that a bean-sized lump that only appeared in the same place when my breast filled between feedings was probably just a little pocket of milk. She agreed, then asked me, “how’s your mom doing?” I had learned a few weeks before my baby was born that my mother had breast cancer—estrogen receptor-positive cancer. It was detected early and hadn’t spread, but she had begun taking Tamoxifen, per the protocol for that kind of cancer.
She was also preparing to move 700 miles away from me the following week. I was a first-time mother with a baby who didn’t sleep; I was going back to a job I didn’t really miss in a month and I hadn’t yet found “suitable” childcare (who was going to replace me? I couldn’t fathom leaving my baby anywhere!); my mother, who lived 20 minutes away from me since I graduated from college over 7 years prior, was moving 700 miles away from me; and she had cancer.
Mom’s oncologist suggested I would want to get a baseline mammogram when I turned 30, less than 4 months ahead. “You’d have to quit breastfeeding to do that,” my doctor said, “but since breastfeeding is supposed to be protective for both you and your daughter, you might as well just get the mammogram whenever you wean naturally.”
I doubt anyone suspected that I’d be breastfeeding children continuously for the next decade—I know I didn’t. There was a study being conducted at the facility where I got my medical care; it was about the efficacy of bioelectric impedance imaging in early detection of breast cancer. The recruiting nurse, after a few years, finally stopped approaching me in the waiting rooms at my childrens’ well-child visits. Instead, she smiled and simply said “not weaned yet, right?” Around my 38th birthday, at my annual checkup, it was suggested to me that I get a mammogram—or even a simple ultrasound image—regardless of the fact that I was still lactating, because my mother was unsure but thought one of her doctors told her she was a carrier of a mutated BRCA gene. If she is (if I am), my risk for developing cancer is disproportionately high. I called around to facilities that should have had a radiologist on hand who could read an image of a lactating breast, but came up empty. In the midst of a career change and dealing with a major medical procedure for one of my children, I gave up trying to get either a baseline image of my breasts or a genetic test for the BRCA mutations. Neither was coming easily and I was tired.
Fast-forward a few more years. My youngest daughter has weaned, I believe. I would be more definite about saying so but, with her 6th birthday approaching this week, she’s still not admitting to having weaned. It’s been a good year and a half since I’ve had any milk, and her weaning has been so gradual that I’ve wondered for over a year whether each time she latched on was going to be her last. I thought she was all done this summer, but she nursed a few more times this fall after my week-day move to Washington. It was only 15 seconds on one side—definitely more for her peace of mind that she could nurse if she wanted to—but I struggled with whether I was still a breastfeeding mother.
The call to get my mammogram holds all of this within it. I’m 40 now; maybe the recommendations are antiquated and maybe the evidence isn’t really supportive of the practice but 40 year-old women get a mammogram. I can face my chronological age with confidence knowing that I’ve employed so many known protective factors over the last 20 or so years: regular exercise, healthy diet, and lots of breastfeeding; but my mother’s history nudges me to remember that sometimes, there isn’t a way to outrun risk.
What makes my heart the heaviest, though, is that, when I present myself for imaging of my breasts, I’m conceding—really, truly conceding that my breastfeeding days are over. I’m no longer lactating, I have no more reason to delay that baseline image. I’m in a new season as a mother, and it’s a wonderful, fun season of children who use toilets (mostly) by themselves, who can appreciate a nice meal at a decent restaurant and be pleasant company during it, who have interests and activities that I love participating in with them. I embrace that things are as they should be, but I can’t promise I won’t cry a little when I report for that mammogram—confronting my advancing age, a family history that’s a little bit scary, and the defining chapter of my life that is now undeniably closed.