Can you tell

I'm up early and have the computer all to myself? Just one more post for now.

So I got a bit of a scare the other day. On the 18th, I went to get a screening mammogram. It's been about 2 1/2 years since my last one, due to COVID, as I'd planned to get one last spring, and then when I made the appointment a couple of months ago it took a bit to get a late evening appointment.

I hadn't heard anything for a week, so I figured they'd just send me a letter saying everything was okay. Then I got a phone call a few days ago asking me to come in for another mammogram, which would be diagnostic, as the radiologist had seen something and wanted more data, and to be prepared to spend 1-3 hours there.

No one wants that call.

Now as you know, I live with a lot of anxiety, and I was really trying to not go into panic mode. I talked to a co-worker who's been through breast cancer and she suggested I call back for more information as to the indications for the new test. After playing phone tag, I got a call from a nurse saying there was no visible mass, but that there was an asymmetry in the left breast they wanted to investigate further. I just assumed that meant there was something different in the left breast vs. the right, and that's true, but it's a specific term in mammography, unrelated to say, differences in size for the breasts. From the summary of an abstract for an article relating a case-study of missed malignancy diagnosis in breast asymmetry:

Summary. The developing asymmetry has a 12–15% risk of malignancy but poses challenges of detection and interpretation due to the lack of typical features of cancer and the frequent absence of an ultrasound correlate. Failure to biopsy these lesions may lead to delayed diagnosis of breast cancer.

Also from the article itself:

Asymmetry and developing asymmetry are seen on 3.3% and 0.16% of screening mammograms respectively. An asymmetry is highly likely to be benign, with the likelihood of malignancy reported at 1.8%. However, 12.8% of the developing asymmetries identified on screening are malignant and therefore these findings require biopsy.

So, it's highly unlikely that it's malignant. They just want to verify that it's not of concern. The radiologist will read it while I'm there. If there is concern, they'll do a biopsy while I'm there, which is why I have to plan on being there so long.

Anyway, I'm glad my co-worker was there to talk to and she really helped. Hopefully it will be nothing. I'll write more when I know more.

Another loss due to breast cancer

Maryam Mirzakhani, First Woman to Win the Fields Medal, Is Dead at 40/

Speaking of scientific studies

This is interesting, and merits further study:

Cattle virus linked to breast cancer: Evidence of exposure to bovine leukemia virus was found in breast cancer cells, however researchers said that does not prove it causes cancer.

Researchers were surprised to find in a new study that a significant number of breast cancer cells from more than 200 women had evidence of exposure to bovine leukemia virus, or BLV.

BLV infects dairy and beef cattle's blood cells and mammary tissues, and was for a long time thought not to be able to infect humans.

Nearly all bulk milk tanks at large factory farms are infected with BLV, but only about 5 percent of cows get sick if they have the virus, according to the U.S. Department of Agriculture. The same group of researchers at the University of California Berkeley involved in the new study also found last year that BLV could be transmitted to humans.

I don't understand why anyone would have done this....

Former Ga. technician falsified mammogram reports

Sharon Holmes found a lump in her left breast quite by accident. At work one day as a high school custodian, her hand brushed up against her chest and she felt a knot sticking out. She was perplexed. After all, just three months earlier, she had been given an all-clear sign from her doctor after a mammogram.

A new mammogram in February 2010 showed she in fact had an aggressive stage 2 breast cancer. The horror of the discovery was compounded by the reason: The earlier test results she had gotten weren't just read incorrectly. They were falsified.

She wasn't alone in facing this news. The lead radiological technologist at Perry Hospital in Perry, a small community about 100 miles south of Atlanta, had for about 18 months been signing off on mammograms and spitting out reports showing nearly 1,300 women were clear of any signs of breast cancer or abnormalities.

The tech was signing various radiologists' names to the documents in order to avoid the paperwork she found onerous. So basically, due to her laziness and lack of work ethic, several women had delayed treatment, and they've had more radical treatment than they might otherwise have had. For this, thanks to a plea deal, she'll serve up to six months plus spend 10 years on probation, unable to work in health care in that time, and pay a fee of $12,500. That seems awfully light considering any of these women might have died thanks to her.

We tend to trust our health providers, sometimes too much, perhaps. While it's one thing for a patient to suffer in some way because of a simple or complex series of mistakes, it's another thing entirely when someone is doing something deliberate without regard for the consequences. FOrtunately those folks are in the minority, hopefully.

I am assuming that these were done through paper charts, and that an electronic health record (EHR) was not in place, because if it had been, then only those with access to the radiologists' credentials (smart card, password, etc.) could have signed for them, making it harder to forge a signature. I suppose it's possible to mess with the system, but it's much less likely than what you can do with paper. Every click I do in the patient's record is recorded, I'm sure, and even if I can't see all the trail, the clinical analysts can. So this is one more argument for implementing an EHR on top of the governmental assistance given.

Bully for her

Breast cancer survivor can now swim topless in Seattle's public pools

Jodi Jaecks, the 47-year-old breast cancer survivor who made local headlines this week for wanting to swim topless at a Seattle-area pool, had tried many things to soothe the nerve pain she suffered following a double mastectomy and chemotherapy last year.
Drugs, physical therapy and specific pain treatments all failed to ease the burning caused by chest-wall nerves that are over-stimulated by the trauma of surgery. So when the facilitator of a breast cancer support group suggested she try swimming, Jaecks jumped on the idea.
"Water sounded soothing," she says.

Unfortunately, she couldn't find a women's swimsuit that didn't irritate her pain further. She asked authorities for the ability to swim topless; she has neither breasts nor nipples. At first they cited the idea that it would not work in a family-pool situation. Then a local paper printed a picture of her nude from the waist up, and the authorities relented, with a promise of reviewing other requests on a case-by-case basis for now, but perhaps eventually opening it up to all breast care survivors.

I understand nerve pain a bit. There are times when my feet are burning and painful, and I have to take my shoes off because I can't handle anything on them. Even the slightest touch is awful. But I can discreetly take off my shoes in public, especially if I keep them under my desk. It's a little different dealing with the chest nerves, and in her case medicine did not work. Anyway, I'm glad she got to swim after all.

It seems to really be a miracle drug

Okay, you have to watch the stomach issue, and Reye's Syndrome in children and young adults, allergies, etc., so it's not without adverse effects, but...

Aspirin cuts death risk after breast cancer: Large study of nurses showed 50 percent lower risk cancer would spread

That's rather remarkable for a very common and cheap drug that's been around in its present form for over a hundred years.

Controversial new guidelines

New advice: Wait until 50 for mammograms--Government panel says benefits of early screening don’t outweigh risks

I actually had my one and only mammogramme at 38, when a doctor ordered it due to breast pain, so there's a baseline. (I was told that I had perfect breasts, something you don't hear every day. Apparently they come out so clear that if I had a tiny tumour they'd be able to see it immediately, whereas women whose breasts are dense and fibrous have issues in having theirs read.) I've meant to have another since I turned forty, but put it off, and now I'm 42 and they're saying not to bother, and they also say breast self-exam is pretty much worthless in terms of evidence. To be honest, I'm not quite sure what to believe. It does actually bring the US in line with international guidelines. I think this is where evidence based medicine can help. I think I'll do some of my own research and go from there.

Sad, but a life well lived

Doctor in gripping South Pole rescue dies: Trapped by weather, she treated her own breast cancer

'More and more as I am here and see what life really is, I understand that it is not when or how you die but how and if you truly were ever alive,' she wrote in an e-mail to her parents in June, 1999 from the South Pole.

Nielsen FitzGerald never lost her adventurous spirit and even returned to desolate Antarctica several more times.

'She had incredible zest and enthusiasm for life,' said her husband, whom she first met 23 years ago when they were both on vacation in the Amazon. 'She was kindest soul I ever met, she was intelligent, with a great sense of humor, and she lived each day to the fullest.'

I am so sorry to hear of the loss of this intrepid woman. My sympathies to her family and other loved ones.

Interesting--and bad for my mother, who works overnight

Overnight shift to be classified as 'probable' cancer cause

My mom is a nurse who works sixteen-hour night shifts. According to several studies, higher incidences of breast and prostate cancer are found in night workers. This may be due to the disruption of the circadian rhythm, as well as the production of melatonin, a chemical produced overnight while we sleep that helps keep cancer at bay. Light impedes melatonin synthesis; on the other hand, while melatonin is available as a supplement, it's not recommended to take it for long periods because doing so may interfere with the body's natural production of it. Those who do swing shift may be at even higher risk, since the body doesn't really get to adjust to a schedule one way or the other. Insomniacs and others who do not work but may not get enough sleep may also be at risk.

Speaking of not enough sleep, I'm operating on five hours from last night and I'll have four tonight. Argh.

Puts my troubles in perspective

You won't be able to read this link freely past the 4th or 5th of October because the Herald-Leader, our local paper, charges for such archived articles, but this story caught my eye. So, I will 'sum up'. Remember the doctor who back in 1999 was stationed at Antarctica and discovered she had breast cancer? I had wondered what happened to her. She'd performed a biopsy on herself with just ice to dull the pain and they made a drop of materials for the slides so she could be sure of the diagnosis and and chemotherapy drugs to treat her. After her return she had a lumpectomy (the cancer had miraculously not spread to the lymph nodes, apparently) and then later a mastectomy due to an infection. She wrote a book (Ice Bound: A Doctor's Incredible Battle for Survival at the South Pole) about her experiences and that was the last I'd heard of her .

Jerri Nielsen was in the area recently giving a talk to raise awareness about breast cancer and she's had further difficulties since then. In 2006 she found out she had bone and liver cancer. A tumour coming out of her skull pushed into her eye socket. She was in Turkey and she went blind. She is now fighting the aggressive form of cancer with chemotherapy, but still tours and practices medicine.

She's an amazing woman. Remember October is Breast Cancer Awareness month. Be sure to do regular self-examinations, get clincial exams as recommended, and have a mammogramme done especially if you're over forty.