On Monday I had a mammogram. It was the first one I’ve had since January 2019. I am not sure why I didn’t go in 2021 — likely a combination of factors, including that during the COVID pandemic time seems to have had no meaning, and some appointments were missed. But in November, I finally booked the appointment.
Later that night, I tweeted out a public service announcement of sorts reminding people over the age of 40 with breasts to get screened. And I got a lot of responses back, including about the process of a mammogram itself. (Not everyone is a fan of the process that some call the “panini press.” I agree. More on that in a bit.)
I had my mammogram done at the Halifax Shopping Centre location of the Nova Scotia Breast Screening Program, which is run by the IWK.
On Tuesday, I reached out to the IWK to get some answers about mammograms: who should get one, wait times, and more. I contacted spokesperson Ben Maycock, who sent along my questions to Trena Metcalfe, the program manager for the Nova Scotia Breast Screening Program.
That program has 11 fixed screening sites across the province, including the one at the Halifax Shopping Centre where I went, and one provincial mobile service that provides mammograms.
The current wait time is 30 to 153 days (I waited about 120 days for my appointment). Metcalfe said wait times fluctuate based on resources at each site. She explained:
Base schedules are opened two years in advance and then additional appointments get opened based on site resources/staffing. Central booking allows someone to book at any site in the province if they are willing to travel and their wait time is longer in their community.
We send reminder postcards three months before clients are due to remind them to book their appointment. We also encourage booking next appointment as soon as the results letter is received with recommended return date to avoid delays in booking.
After you are screened, you will get the results in a letter sent in the mail, usually a week to three weeks after your appointment.
So, who should get screened and how often? According to Metcalfe, the current guidelines recommend screening every two to three years for someone between the ages of 50 and 74. The program accepts self-referrals from patients when they turn 40. Metcalfe sent along these criteria for self-referral:
To self-refer for screening mammography you must not have any present signs or symptoms of breast cancer, no previous diagnosis of breast cancer, and no breast implants. Women 40+ can self-refer. Trans men and gender diverse people can also self-refer if they meet the eligibility criteria.
Annual screening is recommended for people between the ages of 40 and 49, if you choose to be screened. Metcalfe added that shared decision-making with a primary care provider, to determine if screening is appropriate, is encouraged in these age groups.
Metcalfe also sent along this chart of the number of screenings done since 2018. The first column is the total number of screenings for each year, while the second column is the number of breast cancers detected by those screenings (otherwise known as screen-detected breast cancers.)
As you can see, COVID lockdowns in the first half of 2020 had a significant impact on the number of screenings done as clinics across the province closed. The number of screenings was down by half in 2020, and about 10,000 less than pre-COVID numbers in 2021. The number of screen-detected breast cancer numbers for 2021 aren’t available yet.
With the numbers provided, historically approximately 0.5% of those screened will be diagnosed with a screen-detected cancer.
I agree mammograms aren’t always the best process, and I would like to see better technology, which I think would increase the number of people with breasts being screened each year. I joked that someone could design a bra — maybe like Madonna’s cone bras she wore during her Blonde Ambition Tour in the early 1990s — that you could simply slip on and have the girls scanned.
There’s some squeezing, manoeuvring, twisting, leaning, and positioning of breasts, arms, and shoulders required to get your breasts into the machine to be compressed, and then for the image to be taken. The a radiologic technologist who specializes in mammography, who I find are patient and kind, take several images from different sides. When you’re in place — when your boob is squished into place in the machine — you hold your breath, and the radiologic technologist takes the scan. Honestly, it can be more awkward than anything, but everyone’s experience is different.
Still, it’s a relatively quick process. Before my appointment I had a Zoom interview, and after my appointment I hit the road for an in-person interview in the Head of Cheezetcook (that story to come this week). The appointment itself, from the time I walked into the door until the time I walked out, took about 15 minutes. And there’s no prep or recovery; just wear a two-piece outfit and no deodorant or powder. It’s pretty simple.
The squishing isn’t most women’s favourite part. So why is squishing required anyway? Metcalfe described the compression process this way:
Compression helps to spread out the normal fibroglandular tissue of the breast to make it easier for the radiologist reading the mammogram to see through the tissue and detect abnormalities. Adequate compression is also important to prevent motion and blurring of the images and to reduce the radiation exposure required to obtain an optimal image.
A good analogy to use is looking at a bag of marbles with one marble in the bag representing a cancer. Looking at the bag not spread out, it would be very difficult to see the cancer. If you compress and spread the marbles out it would be much easier to find that one cancerous marble. If they were not spread out many of the marbles may look abnormal.
In my Twitter thread about mammograms, a few women said that ultrasounds are available for those women whose breasts may be too small for the usual mammogram. I asked Metcalfe about that and she said:
Screening mammography is the gold standard for breast cancer screening in any size breast. Ultrasound is not used as a screening tool. Ultrasound can be used in diagnostic breast imaging to further investigate an abnormality identified on a mammogram or to investigate a clinical symptom when appropriate.
A few other women mentioned new screening with a simple blood test. Global News reported that a lab in Calgary is working on the blood test that would detect early stage breast cancer. I asked Metcalfe about that option and she said, “I believe the effectiveness of this is still being evaluated and it is not available in Nova Scotia.”
I had my first mammogram shortly after I turned 40 and they found what they described as “dense” tissue that they wanted to check out. So I had a biopsy, and fortunately that dense tissue turned out to be nothing serious. That was in the spring of 2011, and I had annual mammograms until January 2019. Now that I had my screening on Monday, I can get back on track (I’m 51, so that means a screening every two years for me).
So, those are some details on getting a breast screening in Nova Scotia. I know it’s not always pleasant, but as some of the responses in my Twitter thread showed, a screening can detect cancer. If you’re overdue, you can book your appointment here.