Flat: Womanhood reshaped

(This post about going flat has been in the works for a couple of years now. As I dust off my blog, I thought I’d go ahead and send it up.)

Up until they were amputated, I didn’t give my breasts much thought. Like any other body part, they’d been mine for as long as I could remember and, frankly, I found them rather anticlimactic. I dressed them, undressed them, and washed them in the shower.

No big wup.

Occassionally I’d wonder what it would be like to have the kind of breasts I see in the movies. I’d watch a starlet’s double DDs burst out the top of her gown, like my iris bulbs heaving themselves unceremoniously out of their beds each spring, and I’d wonder “wowza, what would it be like to have a pair of those pups?”

But mostly, my feelings toward them vacillated from indifference to annoyance. They annoyed me because I hated wearing a bra, especially in the summer. I wanted the freedom to walk my dog to the park wearing nothing up top but a cool, wispy T-shirt. But, too embarrassed by the bounce-factor, I’d pull on a bra, sure to be damp and sticky within 5 minutes and squeeze my chest like an anemic boa constrictor.

Given my ho-hum attitude toward my breasts, I was (and still am) shocked at the depth of sadness I feel by their passing. The double mastectomy wiped my chest clean. If it weren’t for two, neat scars, you’d never know they’d existed at all. I wonder if I’ll forget what they looked like, like the fading memory of a past lover.

Dana Jennings, my favorite NYT blogger, wrote here about how his erectile dysfunction (a side effect of prostate cancer treatment) made him reconsider what makes a man. The one sentence that resonated most deeply for me is: “I’m just trying to understand, trying to articulate, what it feels like to be damaged goods in our oversexualized culture.”

Some days I feel like damaged goods. Those days are often sparked by a look in the mirror. As both a yogi and a yoga teacher, I spend an inordinate amount of time in mirror-lined yoga studios, dressed in tiny tank-tops, surrounded by other women in tiny tank tops…most of whom are under 30 and all of whom have breasts. Now, I’ve always had a pretty healthy body image, but, on a daily basis, this scenario can kick my sense of womanhood in the teeth.

Of course, as Jennings points out, being a man or a woman is about much more than the fleshy bits. But, in a culture obsessed by the fleshy bits, being without them makes me feel “less than” in some intrinsic way. The deep sense of loss I felt after my surgery and continue to feel shocked the pants off me. At least once a day, I am caught off-guard by a stabbing sense of sadness.

I still avoid looking in the mirror when I step out of the shower. And trying on clothes in women’s dressing rooms is like entering the 6th circle of Hell, between the flourescent lights and the fact that the article of clothing I am about to slip over my head may fit nicely or it may droop listlessly, extra material bunched like two flat tires pinned to the front of my chest. I have fleeting moments of wondering what reconstruction would be like. Wondering if I would be happier. Wondering if it would be fun to have bigger breasts than I had before. But then I slip on a cool, crisp T-shirt leash the dog and walk out the door reveling in my new found freedom.

What The Cluck?

Holy crap. I thought pink washing had hit rock bottom, but cause marketers have one-upped themselves with a new pinkwashing campaign linking Kentucky Fried Chicken to the Susan G. Komen Foundation.

KFC’s campaign, called Buckets for the Cure, donates 50 cents to the Komen Foundation for every pink bucket “purchased by restaurant operators” between April 5th and May 30th, 2010. In an effort to raise $8 million in six weeks, according to Komen’s web site, “The lids of these special pink buckets will have a call to action to get involved. Names of breast cancer survivors and those who have lost their battle with breast cancer will be listed on the sides of the bucket.”

The same bucket that packs up to 2,400 calories and 160 grams of fat. Hello? Does anyone at Komen care that obesity causes breast cancer? Or are they too busy selling us out to the lowest bidder? Seriously. You can’t make this stuff up. The web site comes complete with a rotating pink bucket of fried chicken plastered with thumbnail-sized pictures of breast cancer survivors. Click on the picture to find out more about these poor saps being manipulated by the marketing geniuses at KFC.

I borrowed my blog headline from the clever folks at Breast Cancer Action who’ve skewered breast cancer marketers for years with their “think before you pink” campaign. The non-profit’s web site notes that Buckets for the Cure is “especially egregious because KFC, like most fast food chains, is overwhelmingly present in communities that have poor health outcomes.”  Click here to visit Breast Cancer Action’s web site and send KFC and Susan G. Komen an email telling them where they can stuff their bucket.

The Mammography Debate

Last Fall, I gave a celebratory cheer when the new mammogram guidelines hit the news. As a health reporter, I’d long been privy to the fact that there is no medical evidence supporting annual mammograms for all women over 40. And it drove me nuts that no one seemed to care. All women over 40 kept lining up to get their boobs squished every year, like clockwork.

“Eureka!” I thought when I saw the headline. “Someone finally came to their senses.”

That someone was the United States Preventive Services Task Force, a 16-member panel of experts. Our tax dollars pay them to peer into such pressing issues as—does breast cancer screening really work?

Peer they did, and what they found was a dearth of scientific evidence supporting the current guidelines of annual mammograms for all women over the age of 40. As it turns out, breast cancer screening for all is not only a waste of time and money but the annual event feeds a cauldron of fear and erupts in false alarms for hundreds of thousands of women.

Here’s one way to look at the pros and cons of mammograms for all women over 40, via the NYT’s “Gauging the Odds (and the Costs) in Health Screening:”

The numbers show that about 2,000 women need to be screened regularly for a decade to avert one breast cancer death.

But…during that decade up to 20 women screened will be “overdiagnosed” and get radiation, chemotherapy or a mastectomy unnecessarily.

About 5 to 15 women will get treatment at a younger age than they would have otherwise, without improving their health outcomes.

Most were going to do fine without screening by beginning treatment of their cancer when the symptoms became evident,

…and a few were destined to die whether or not they had early screening because their cancer was fast-growing.

So, unless a woman has unusual risk factors for breast cancer, the Task Force recommends screening start at age 50 (not 40) and happen every two years (rather than every year).

Seems simple enough.

So, a few weeks later, when Mary and I were face-to-face with our primary care physician, I asked, if Mary (who had recently turned 40) should get a mammogram.

Of course, this was a trick question. Like the validation-seeking patient I am, I wanted my doctor to say, “Why, no. As a matter of fact, the scientific consensus shows that Mary getting a mammogram is as useful as me waving a magic wand over her tatas.”

Time out for a confession: A part of me (the scared shitless part) wanted Mary to get the damn mammogram. I wanted her to line up like a good 40-year-old, get her boob squished, and get the all-clear sign. Because, like every other woman, I desperately want to believe that breast cancer screening works.

But it doesn’t. At least not the way we want it to work. And, yes, I was being hypocritical. How could I ignore the numbers? How was I different than people who refuse to face facts in global warming or evolution? In my darkest moments, I even found myself gently coercing Mary to get the mammogram. “Why not just get a baseline?” I said in my most sensible, medical-reporter voice.

Back in the doctor’s office, my rational and irrational selves were clearly in a tug-of-war. I desperately needed our doctor to squelch my panic. I needed her to be a bastion of evidence-based care.

So imagine my disappointment when she didn’t skip a beat. “Oh yes,” she said, “go ahead and schedule one. We aren’t going to change our recommendations based on one study.”

Whoa, wait a second. This wasn’t a single study. The new recommendation was the final distillation of more than a dozen studies involving more than 600,000 women. The Task Force is made up of the top experts in the field.

Is my small town doctor really second guessing their work? Or is it just easier to ignore the facts and placate women’s fears?

Last month, an editorial in the Annals of Internal Medicine reminded me of the tightrope doctors walk (not mine, obviously, but others) when it comes to managing evidence-based care with patients’ emotions. As reported by the NYT, the editorial shows “a divide has merged between doctors and patients—with doctors more inclined to accept the new recommendations and the patients wanting to stick to early and annual screening.”

I think it’s time that women (myself included) buck up and face facts about the limitations of mammography. Demanding that doctors practice defensive medicine serves no one, especially women. Mammograms offer nothing more than false reassurances in a world where breasts have come to be seen as ticking time bombs.

Easy for me to say, I will never need another mammogram—one of the few perks of double mastectomy. But I hope that next Fall, when Mary’s annual appointment rolls around, I’ll be calm and rational enough to weigh the facts and give her my blessing…to cancel it.

Something About Mary

I know it’s cliché to wax poetic about one’s lover on Valentine’s day but I don’t care. I’m seizing the day—every last gooey, sugary, chocolate-covered drop of it—to blog about Mary.

Like good lesbians, we met in San Francisco’s Mission district. She was gathering herself for the leap to grad school in San Diego. I was working at Sunset Magazine. Strangers, we arrived simultaneously on the doorstep of a friend’s party and chatted as we waited to be buzzed inside. She didn’t know it, but I’d trailed her down Valencia Street. Her red raincoat bobbing and weaving in front of me. She exuded a sense of upbeat urgency and I caught myself wondering who she was…wondering if we were going to the same place…wondering how she walked so fast! When I finally caught up to her, in front of our shared destination on Bartlett Street, I was smitten. She didn’t know me yet she held my gaze with a warmth, openness, and authenticity I’d rarely seen. This woman had her shit together. She had nothing to hide. I was in awe. Soon, I would be in love.

That was more than eleven years ago, and, whoa Nelly, it’s been a wild ride. Like most couples, we are the yen to each other’s yang. We love each other like crazy, drive each other nuts, and spend more than our fair share of time in therapy figuring out how to ride in tandem—each motoring toward individual and shared goals with no one getting run over in the process. We’ve chipped away at some big life lessons, but my cancer diagnosis felt like skipping from 8th grade to college in “relationship school.” Every day, or so it seemed, we blew through another grade. As our intimacy deepened, layers of fears and insecurities sloughed away.

The first welcome casualty was my decade-old fear of finishing second place behind Mary’s job in the race for her affection. The minute the shit hit the fan, Mary dropped everything. And I’m not talking about the average person’s “everything.” Last winter, Mary was on the brink of tenure—a six-year-long slog toward the finish line in a cut-throat academic job that left little room for error. (And by “error” I mean taking time off to care for your partner.) Academia is a relationship killer and we were limping toward the finish line, bandaged and bruised but still together, when the C-bomb dropped. Without a moment’s hesitation, Mary put her work aside to go with me to every appointment, research treatment options, contact surgeons, answer the phone, walk the dog, run out to fill prescriptions, change my bandages, and empty my drains. And she wasn’t just a nursemaid, this woman was by my side mind, body, and spirit.

My anxiety was show stopping. Every morning, I’d wake up before dawn to ruminate about my impending death. Without fail, Mary would wake up, gather me in her arms and talk me off the ledge. She’d help me round-up my shiny new collection of cancer fears, pack them up in a box, tape down the lid, and stow them on the top shelf of my mental closet. Day after day, morning after morning, she led me out of my dark place with patience and compassion.

When I hit rock bottom, I packed up my emotional bags and checked out of my body. That escape route that was only made possible because I had Mary to lean on. And lean I did. That weekend she drove me to Louisville to see my family, sat through a 2-hour visit with an alternative practitioner without batting an eye at his bizarre treatment approach or his stratospheric rates, stood in a line (20-women-deep) for a dressing room so I could try on a pair of jeans to fit my new cancer-fit figure, and, on our way out-of-town, drove 20 minutes in the opposite direction to buy me formaldehyde-free nail polish.

Maybe, most amazingly, is that through it all, she never let me see her sweat, never let me feel like a burden, never made me feel like my mood swing, fears, and mental check-outs were anything other than 100 percent normal and acceptable. She never added her own fears to my own raucous pile. Instead, she skillfully caught each one by the tail and caged it until she could release it safely in the company of a close friend or family member.

After more than ten years of loving this woman, I am still in awe. And I am more in love than ever.

Radiation Mishaps Make News

As I’ve discussed here, I suspect radiation played a role in the onset of my breast cancer. How big of a role? I’ll never know. But between the ages of 12 and 14, I regularly received blasts of radiation for the monitoring of scoliosis. I don’t know exactly how many x-rays came my way in total, but I do know that protecting my breasts was never mentioned.

Later, as a health writer, I grew increasingly wary of medicine’s willy-nilly use of radiation. My concern escalated in 2008 when I wrote a piece for Time Magazine about the potential hazards of CT scans, especially for children. The basis of the story was two studies indicating an increased cancer risk associated with multiple CT scans. I was blown away to learn that each CT scan packs as much radiation as up to 500 conventional x-rays. Of course, CT scans can be a life-saving diagnostic tool and should absolutely be used when necessary, but my reporting found that they are widely overused.

Not to mention, the operator-error factor. One of the most disturbing tidbits I uncovered in reporting that story was from a CT technician who admitted that even though newer scanners can be adjusted to give children up to 50% less radiation (a standard recommendation), many technicians simply forget to reset the machine.

Needless-to-say, I was thrilled to see the New York Times tackle the issue of radiation safety these past couple of weeks, and I want to help them spread the word. What first grabbed my attention was this article about the lack of radiation safeguards. The people most often in harm’s way? Cancer patients.

Thousands of radiation errors are made every year, many of which are never reported to the FDA. Here are just a few of the most egregious examples from the NYT’s coverage, When Medical Radiation Goes Awry:

  • Patient A had just completed treatment for a brain tumor and received additional radiation intended for Patient B, who had breast cancer.
  • A 31-year-old woman with vaginal cancer was overdosed because of confusion over the method of measuring the strength of radioactive seeds…causing an overdose of radiation to her rectum and vagina.
  • A doctor implanted radioactive seeds in the wrong location in a patient with prostate cancer. The radiation oncologist then failed to promptly interpret a post-implant CT scan, which would have revealed the error.
  • A patient with breast cancer received a 50% overdose for 10 treatments because a wedge (a gadget used to shape the radiation beam) was mistakenly left out.
  • Another breast cancer patient, 32 years old, received 27 days of radiation overdoses (three times the prescribed amount).

Thankfully, I’m not the only person who was flabbergasted by the magnitude of these medical errors. The NYT’s coverage culminated today in the news that the FDA is finally going to “take steps to more stringently regulate three of the most potent forms of medical radiation, including increasingly popular CT scans.” I’m not a big fan of the FDA. I think the agency is spread too thin and given too little resources to get the job done. But, at the very least, maybe, someone is finally paying attention.