Cancer Phobe-A Doc faces her Breast Health Fears

April 2nd, 2012

Today is my second vacation day of the year.  No, i’m not in Bermuda ):

I’m taking two days to do the kind of stuff every human needs to do.  I’m organizing my life and checking off my personal “punch list”.

First on my list is making my yearly trips to the doctor.  Usually I see the dentist twice a year, but since I moved last year I’ve yet to re-establish care in ANYTHING.  Time to take control.

So, first thing this morning (after cereal and coffee of course) I called my own hospital’s scheduling line to find me some new doctors.

Since I plan to have children in the next few years, I’m going to keep my primary care with a generalist OB/Gyn.  I need a pap smear/pelvic and some general pre-(very VERY pre) natal counseling. CHECK! Got it with someone who has clinic on my research day so I can schedule follow ups conveniently.

I also scheduled my dental cleaning.  I hate it, but my teeth are now quite valuable if you count the thousands of dollars in braces, bionators, and veneers that have graced my pearly whites over the years.

Next I faced something I’ve been meaning to do for a few years–a cancer risk assessment clinic.

Let me just say I am a HUGE cancer phobe.  When I was in my fourth year of med school, I sat down in the MICU one day and rubbed my sore neck muscles–only to find a “larger than the upper limit of normal” lymph node.  I had a few in other areas as well, so like a good med student I flipped out and convinced myself I was going to die from lymphoma.  Ten-thousand dollars later (yes m’aam, 10K smackeroos before my co-pay), I had a lymph node biopsy to tell me I was OK.

Years before, I had had another cancer scare.  One that hit a little closer to home.  When I was 17, I found a lump in my breast in the shower.  Of course, I flipped out then as well.  I went to see a surgeon who did a breast ultrasound.  I had the lump removed and was reassured it was benign–a fibroadenoma.  Pretty common, I know now.

It hit close to home because breast cancer is prevalent in my paternal grandmother’s family.  She had a sister who died of it in her thirties, and a niece who developed it in her 40′s.  A few years later, she herself would get breast cancer.

Now, my grandmother was in her 70′s, and it was metastatic mostly because she never went to see doctors and ignored her cancer until it grew to the size of a baseball.

She ignored it probably because she was scared and knew it was cancer. 

Can I blame her?  No, I can’t.  I can’t without being a hypocrite.  I am terrified of breast cancer, and I don’t do breast self exams for that very reason.  As an anxious person anyway, I know I’m going to feel funny lumps and bumps and convince myself it’s cancer.  Again, just like the prior two times.

I’m not without some justification–screening brings a lot of anxiety and false positives.  There was even one large randomized controlled trial of breast self exams in China that didn’t show a benefit of mortality reduction and did show an increase in the diagnosis of benign breast lesions in those who perform BSE’s (“Randomized trial of breast self-examination in Shanghai: Final results,”Journal of the National Cancer Institute, Oct. 2 (vol. 94, issue 19) 2002).

 

But I can’t ignore some facts:  I’m over 30 and childless (increases chances).  My age at menarche also gets me a couple of notches.  The fibroadenoma as a teen moves me up even farther.  Finally there’s my paternal grandmother and her breast cancer clan.   Thank goodness neither of her two daughters, my aunts, have had any problems, and they are approaching their 60′s.

So, I’ve decided to go talk to someone.  I filled out my family tree at family history.hhs.org.  I was unhappy i couldn’t add to my grandmother’s side, though, so I’ll have to hand-write it onto the tree.  I’m sure there are other family history apps that could help out with this.

What I’m hoping to get is an opinion on whether I should begin screening with mammography at the recommended age of 40, or if I should start sooner with a different modality such as ultrasound or MRI.

For all of you out there who fear cancer, you are not alone.  Even us doctors can be illogical about cancer.  Don’t let your fear control you, though.  Take charge, take a deep breath, and talk to your doctor.

Sigh, I just remembered another fear–skin cancer (I have tons of moles).  Time to call Loyola again. This time for the dermatologist . . .


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    Professional Gastroenterology Fellow

    Amateur Martha Stewart/Bob Villa/Julia Child/Collette Peters

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