The mammogram callback blues

An ode to dense titty sandwiches

Photo credit: Charlie Bielanko

Days that move like syrup. Heat tired. Work tired. Like a neverending vacation hangover, I can’t get into a productive groove of any kind this summer.

I pour my lethargic body into the minivan to drive to a mammogram appointment I was supposed to make in May but kept forgetting. Or subconsciously putting off and labeling it as forgetting?

Like anyone, I dread flopping my 46-year-old titty onto the cliff of the mammogram machine so the mammographer can make titty sandwiches out of me and the machine while checking for the cancer I am certain is imminent while I nervously make bad boob jokes like a 17-year-old aspiring stand-up comic.

Boobs, amirite? wah wah wah

On the short drive to the appointment, as I always do, I play out the worst-case scenario in my head: The Diagnosis. I will be stoic when I receive the news. Cory, who has had cancer and who will be with me when it happens, will marvel at my bravery. I will nod my head slowly in stolid un-surprise and calmly ask the doctor about next steps. Cory will cry and I will courageously comfort him.

God, I’m so full of shit. How does Cory put up with me?

Like my hair going gray or the furrow between my eyebrows deepening into full-blown resting bitch face, I’ve always assumed a bout with cancer was on my middle-age horizon. Breast cancer specifically seems inevitable these days. Everyone knows three, four, half a dozen women who have been diagnosed. And we’ve all known women who didn’t make it. Moms, aunts, sisters, friends, and strangers. I have worm-holed the Instagram pages of many gutsy women with a feeling not unlike rubbernecking a horrendous freeway crash. Beautiful, brave women who chronicled years of valiantly fighting to survive until a final post from a loved one indicates their war is over.

I hate myself for being on Instagram but I also like the connection with real people from my past that I love and will likely never see again except on social media. But the social media beast is largely a massive turn-off. The performative nature of it all. And even the people who seem genuine eventually morph into caricatures of themselves and start to believe their carefully curated narrative. Do me a favor; if I start posting my own quotes, unfollow me pronto.

Do me a favor; if I start posting my own quotes, unfollow me pronto. - Monica Danielle

When you are constantly validated by strangers who don’t really know you in real life, who is the real you? Internet reality is a form of reality, I guess. A lot of people seem to live in it more than real-life reality. And who am I to judge? Here I am tap-tap tapping away on the internet, presenting you with a version of my life.

I think about everything way too much. Why I’m on social media, how much beer I drink, why I drink it. Fuck, I love beer. And I hate it. I’d be doing myself a huge favor by eliminating social media and beer altogether. But both are easy coping mechanisms when my nervous system is jacked and I need to let my brain gently float. Two beers + scrolling hilarious animal vids on Instagram is my Valium, baby.

While I wait to be called in for the mammogram I finger my earrings, wondering if I should take them out. Is a mammogram like getting an X-ray at the dentist? Does wearing earrings skew my results? Like debating if sneaking off a quick text during takeoff can bring down a 747 aircraft, can tiny gold hoops mean the difference between life and eventual cancer death?

My earlobes are always mad at me. They’re constantly infected so I try to leave the same earrings in as much as possible. I’ve had pierced ears for more than three decades and my lobes still slobber at me like rabid dogs. The holes want to close up, angry skin knitting ferociously together if I go even just a few days without earrings. Meanwhile, my belly button ring hole gapes like the surprise face emoji even though I wore a ring in it for only about ten minutes in high school before ripping it out in annoyed exasperation.

Later, after the mammogram titty sandwiches, when I see an email from my doctor with the subject “You have a NEW LETTER available in Mychart” I click on it without concern because, in spite of my certainty that breast cancer is looming around the corner, the five clear mammograms I’ve had throughout my forties have lulled me into a deceptive comfort zone. I was wholly unprepared for what I read.

Instead of the “I have read your recent breast imaging exam and am pleased to tell you there was no evidence of cancer” I usually see, the letters form into words that say “The results of your exam indicate the need for additional evaluation at this time.”

Well fuck.

I’ve always assumed if the news was terrible I’d get a phone call so maybe an email means it’s no big deal? Or maybe we’ve gotten to a post-COVID, remote work, telehealth place with online communication where even terrible news is relegated to email now? It’s a digital world, baby! My mind wonders about these things as my eyes scan the results of my mammogram.

FINDINGS:

Left
The left breast is heterogeneously dense, which may obscure small masses.
There is no evidence of suspicious masses, calcifications, or other
abnormal findings in the left breast.

Right
The right breast is heterogeneously dense, which may obscure small masses.
There is no evidence of suspicious calcifications. There is a focal
asymmetry in the posterior upper outer quadrant seen best on tomo images.

Recommendation:
Screening mammogram in 1 year is recommended for the left breast.
Callback ultrasound is recommended for the right breast.
Callback diagnostic mammogram is recommended for the right breast.

Weirdly, I feel a misplaced spark of pride that my breasts are being called dense even though that has no bearing on anything. It’s not like “heterogeneously dense tits” is anything I’d put on a Tinder profile. “Love wit, good conversation and have the densest breasts!” It just seems like a compliment, you know? A nice thing for boobs to be.

I show Cory the email and surprise myself by promptly bursting into tears. So much for my stoic diagnosis fantasy. This is just a mammogram callback and I’m already bawling.

Of course, I immediately google “focal asymmetry.”

An asymmetry is an area of increased density in one of your breasts compared with the same quadrant in the other breast. Focal asymmetry refers to localized areas in one breast that look different from the corresponding areas of the other breast. A focal asymmetry must be smaller than a single quadrant in any area of the breast. It must also appear on two or more views (angles) of a mammogram for a radiologist to consider it a focal asymmetry. Focal asymmetry does not mean you have cancer. While some cases may be due to a malignant mass, it is most often due to other causes. Still, it warrants further examination. source: BCRF.org

Okay then. Alright. This seems manageable. Right? There is no talk of solid masses or lumps measured in centimeters, just asymmetry. Shit, my titties have always been asymmetrical, the left one bigger than the right. No big deal, they just wanna double check my dense breasts. A good thing. The more eyes on my dense breasts the better, is a solid personal policy! Especially because it can be harder to detect cancer in dense breasts.

It is worth imparting the fact that breasts can be mostly fatty tissue and that shows up as black on a mammogram which means a white tumor will stand out. In contrast, dense breast tissue is very fibrous and shows up white, which can hide potentially deadly masses which also appear white on a mammogram.

Breast density—the ratio of connective and glandular tissue to fatty tissue—is also associated with an increased risk; women with more than 75 percent dense breast area have a four-to-six-fold increase in breast cancer risk compared to women with less than five percent dense area (mostly fatty tissue).

This increased risk is due, in part, to the difficulty in detecting suspicious lesions that may be masked by dense tissue and missed by mammograms. Studies have also shown that the genes associated with having dense breasts are the same as those for developing breast cancer, suggesting that the increased risk of breast cancer in women with dense breasts is multi-factorial. source: BCRF.org

The days leading up to the follow-up mammogram and ultrasound appointment move slower than molasses in January. Time has all but stopped. Even though you’re mostly sure you’re ok, there is always the possibility they find something lurking in all that dense tissue. We’ve heard all the stories, right? The stories that end in nothing and the stories that end in something. The stories without a happily ever after. Your mind can’t help but spin out on all the What Ifs, forcing you to confront your mortality.

Death is always a heartbeat away, it’s the nature of life. It’s always hovering right there beneath all the living. A mammogram callback is an unpleasant fork in the road. One direction leads you to a walk around a lake and the other is you potentially drowning in the lake.

I feel afraid, but mostly I feel awake. Aware. There is anxiety, of course! But I am trying to lean into the anxiety as a part of this process. In accepting my fear I realize I am also grateful for the scary reminder that my life - which I bitch about ALLLL the time - is so fucking precious and I am beyond thankful for this healthy body that has moved me through this existence relatively unscathed thus far. My beautiful body with all of its scars, annoyances, aches and pains has tolerated a lot of bullshit from me and it’s still here working its ass off for me. That brow furrow I scowl at every morning in the mirror ain’t shit compared to breast cancer.

Thank you, body. You are a trooper.

And if one of the What Ifs that has played through my mind since the callback email should become reality I’m prepared for that, too. Ready for the life lessons the experience will teach me that I would not have been able to learn otherwise.

*****

Last night. Just me and Charlie, my 9-year-old son. My baby. It’s our date night. His siblings are with their other parents, Cory is out of town. We eat takeout on my bed and watch an action-adventure flick starring Dwayne Johnson because Cha loves The Rock.

Later, my boy shyly asks me if I can teach him to dance and my heart flip-flops in delight. It’s like a scene out of a coming-of-age movie from the sixties. Us in the living room, stepping back and forth across the old sixties hardwood in a circle of warm lamplight as Billie Holiday spins on the record player, filling the house with her blues.

I peek at Charlie’s face in the mirror when he doesn’t see me looking. He’s so serious, so into it, trying so hard to twirl me, dip me, and move me smoothly across the floor and I can see how much he loves me, loves being alone with me. It fills my entire being with light. Heart pounding, chest tingling, brain illuminating light.

I am so thankful. Amid all the hard shit I am going through this year, I am so fucking grateful. For my body, my mind, my family and my friends.

I am here in this moment, recognizing it for what it is: A Top Life Moment right in the middle of a bunch of really tough moments, a thing I hope to think about on my deathbed, whenever that time comes.

It’s all just the yin and the yang, isn’t it? It’s the tough moments that enable us to recognize the top moments.

Oh, life. You wild-ass bitch.