Mammogram while lactating?

Going in for a mammogram is a rite of passage for many women in their mid-30’s and 40’s.  We don’t really discuss it much – we just do it. As the demographics of the family changes and ages, more and more mothers are coming with questions about this scenario – they are of the age to lactate and to have breast cancer screenings on a more regular basis in the same years.

I am not a doctor or IBCLC, I am relating my story in the hopes that the experience and further resources will be helpful to others in similar shoes…

I sit and fill out the typical medical questionnaire forms in the waiting room with my daughter, A.  The ones where you check age of first period, number of live births, smoker/nonsmoker, relatives with cancer, surgeries, and more… one question stumps me because it asks me if I have any liquid coming out of my nipples.  I know this is an important question for other women because there could be cancer or infection but in my case, it is simply my milk.  Z is 3 years old and nurses a couple of times a day (early morning, nap, evening and some random other times) I circle “no” but I write in “breastmilk” and put a smiley face.  🙂

I am standing in a dressing room, patient robe in one hand, my coat in the other.  I have an appointment for a mammogram today and I am feeling very flustered.  I was just told by the nurse that she isn’t sure if a breastfeeding woman can have a mammogram at their breast center.  Luckily, this is not my first mammogram and I have done my research. Yet, I feel upset, confused, and ready for an argument.  The nurse goes back to the radiologist, while I sit and wait.

I am not a person who takes no for an answer very easily so I am not planning on walking out on this.  I am also not a person who gives in well when given time-lines or deadlines so the idea that I wean to have a mammogram is just ridiculous to me.  I am a person who does go in to my healthcare providers for annual screenings and preventative or proactive testing so this is on the agenda this year.  I eat fairly well most of the time, exercise in some form a few times a week, try to get enough sleep and so forth but cancer is something that seems to sneak up on many people.  So, when I went in for my annual gynecological check-up, the doctor reminded me that I am now the age for mammogram and breast cancer screening and was due for my second mammogram.

According to the American Cancer Society the guidelines for yearly mammograms start at age 40.  This baseline age used to be 35 and it varies by state as far as mammogram coverage laws so check your local information and your personal health history before making a decision yourself. I had one at 35 and I am now 41 and here for my second.

http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-paying-for-br-ca-screening

Breast Cancer Before Age 40 Years

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894028/

A mammogram is a screening tool for breast cancer.  It is not a diagnostic tool but something to do before symptoms or if there is a concern that someone has symptoms. A diagnostic tool would be a breast biopsy.

All women should know how to perform a breast self-exam and do it monthly along with a yearly clinical physical exam.  If you are premenopausal you can try to do it a few days after your period ends (so that you can find a time when you feel less tender and lumpy) and if you are postmenopausal you can simply pick a number and stick to that date each month.

Here were my questions:

Will having a mammogram lead to inaccurate observations and more unnecessary testing or will it be something that leads to concern when there is none?  Breast tissue is glandular, fatty and connective tissues.   The anatomy of a lactating breast includes an average of 9 working milk ducts as well.  When having a mammogram, the fat is the easiest tissue to see through… so many moms are told their tissue would be “too dense” to see though while lactating.

Why go during lactation then?  Well, there are factors to consider.

I am of the current age range so I was not going to skip it or wean for it.  Ask about the experience of the radiologist in viewing and reading different women’s breasts (both lactating and nonlactating) and if there is concern between utilizing different techniques, such as films or digital screens to view denser breasts. Bring in any previous mammogram reports or tests to compare this current one (mine was in a different state and over 6 years ago so I wish I had done this because it caused delays!)  and be honest and open about personal family/genetic history and your current lactation status.  It is especially important to have accurate screenings if lumps or changes are of concern.

In my case, I go back and get squished by the friendly nurse who tells me the radiologist isn’t sure about breastfeeding and her ability to read my test.   Although I am a bit miffed at myself for not calling ahead to research the place more than taking the Gynecologist referral, I tell her that I think I’d like to go for it anyway.  I am here already and just want to get it done and over with.   For those who have never had a mammogram done, it is not painful but it is quite odd to stand with your top off (remember not to wear a dress or one piece) and have a nurse move your body around and smush it…to see your breast flattened out in a way you never thought possible and to try to act completely normal about it.  She asks me if I am wearing deodorant before moving forward.  As we prepare, I make the wise cracks she’s probably heard a thousand times.  Yet, I think to myself how upsetting this would all be if I was a new mom or had not known my options before heading into this office.

My previous mammogram at 35 was a different experience.  At that time, I called a few La Leche League friends to find out about offices in the area.  I brought in S and my husband with me, who was a few months old at the time and he nursed just before the mammogram.  He was nursing fairly frequently so I knew I would be full and need to be as empty as possible.  If you can’t bring someone with you – know the baby can’t be in the mammogram room – so think about where the baby will be or leave your baby with a care provider but bring your pump.  I went early so that I would still be ready for the time my appointment was set for and called ahead to speak to the staff about needing time and space to breastfeed before the mammogram.  They were friendly and helpful and the radiologist read my results right in front of me afterwords while I held S in a sling.

By the way, the results came in the mail this time… everything looks normal.

References:

Can breastfeeding mothers get mammograms?

https://www.llli.org/faq/mammogram.html

Web MD Breast Cancer and Breast Self-Exam

http://www.webmd.com/breast-cancer/guide/breast-self-exam

Anatomy of the lactating human breast redefined with ultrasound imaging

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571528/

Mammograms Fact Sheet

http://womenshealth.gov/publications/our-publications/fact-sheet/mammograms.cfm

Breast Health in Lactating Women

http://www.llli.org/ba/may01.html

The Cancer Genome Atlas

http://cancergenome.nih.gov/

BreastCancer.org

http://www.breastcancer.org/

Breast-Feeding after Breast Cancer is O.K.

http://healthland.time.com/2010/10/20/breastfeeding-after-breast-cancer-is-okay/

Accuracy of Diagnostic Mammography and Breast Ultrasound During Pregnancy and Lactation – American Journal of Roentgenology

http://www.ajronline.org/content/196/3/716.full.pdf+html

Common Questions About Breast Cancer Detection

http://www.nwh.org/home/newsletter/2010/breast-cancer-detection/

The New Demography of American Motherhood

http://pewresearch.org/pubs/1586/changing-demographic-characteristics-american-mothers

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