Let’s review: Trust breasts

White bra

Hi. My name is Ima Frawde, CPM. The initials after my name stand for “certified professional mammarist.” I am an expert in normal breasts.

I don’t know about you, but I am sick and tired of the hegemonic, patriarchal, male medical system that is constantly telling women that their breasts are “broken” and need to be scanned regularly to detect breast cancer. Breasts are designed perfectly.

Are we suppose to believe we’re inferior to squirrels, cows, rabbits and elephants? We have about 5000 species of mammal and we’re encouraged to believe that we’re the only one that needs routine mammograms. How did we managed to get along for thousands of years before mammography? If breast cancer were really that dangerous, we wouldn’t be here as a species.

It’s not a coincidence that my comments sound similar to those made by Ina May Gaskin on Feministing. Ina May is my hero. Everything she says goes double for me (heh, heh, heh, just a little breast humor).

Why should you listen to me? As a CPM (certified professional mammarist), I am an expert in normal breasts. In fact, certified professional mammarists are trained specifically to manage breast health at home. In order to obtain my certification, I had to meet rigorous standards; I was required to submit a portfolio of 20 breasts examined within the home (right and left breasts are each counted separately). Plus I had to observe examination of an additional 20 breasts done by my preceptor. That means I had contact with 20 separate women before I began practicing on my own!

How did routine mammography become so popular? As my friend Ina May says, it’s all the hegemonic, patriarchal medical system “which views women’s bodies as defective designs and allows for profit to be made from women’s fears of their own bodies.”

In fact, it is fear that causes breast cancer. How do we know? Primitive women don’t get breast cancer. Think about it. All those charities in Africa are soliciting money for malnutrition, infant mortality, maternal mortality, and obstetric fistulas. Have you seen even one commercial for an African breast cancer charity? That proves it.

What? You don’t believe that fear causes breast cancer? You mean you deny that there is a mind-body connection?

Once you understand that fear causes breast cancer, you can see why trusting breasts is the best way to ensure good outcomes. Having a routine mammogram in unnecessary when you trust breasts. Mammography has a high false positive rate, and those false positives lead to a cascade of unnecessary interventions like breast ultrasounds and breast biopsies, not to mention undermining women’s faith in their own bodies.

But you shouldn’t think that certified professional mammarists reject technology. Far from it. If we feel a breast mass and it gets bigger despite breast affirmations, cranio-sacral adjustment, blue and black cohosh, garlic and Hibiclens, we refer women to breast cancer specialists. Since breast cancer is very, very rare, particularly in low risk women, we have very low referral rates.

Are we always correct? Unfortunately, no, but some women are just meant to die from breast cancer. They probably would have eventually died in the hospital anyway (it might have been 10 or 20 years later, but the principle holds true).

We’re also working on developing our own technology for identifying early breast cancer. We are creating our own mammography equipment. Even as we speak, several groups of women are currently fabricating mammography machines to our own specifications; they are knitting them from steel wool!

Our machines will have two major advantages over conventional, Western, allopathic mammography machines. First, they won’t involve painfully compressing women’s breasts, and second, they don’t use ANY radiation at all. As soon as the mammography machines are fully knitted, we plan large qualitative studies comparing the experience of having a mammogram with a knitted machine vs. a conventional machine.

You might be wondering why we are bothering with mammography machines at all. In answer, I will paraphrase anthropologist and midwife Melissa Cheyney:

The rituals of home breast care are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Home breast care rituals, are also self-consciously political in their intent. As the popular bumper sticker “Mammarists: Changing the World One Breast at a Time” suggests, home breast care is a performative medium for the promotion of social change.

This piece is satire. It first appeared in January 2012.

  • Frum Lady

    sounds like another hippy on drugs has won a place in Nashville’s hall of fame…

  • Lisa from NY

    OT: My doctor sent me for a mammogram. My anti-vax friend insists that mammograms CAUSE breast cancer. Is there any truth to this?

    • Certified Hamster Midwife

      Only in the sense that mammograms catch early-stage breast cancers that may or may not develop into something lethal.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        But there are also patients who do not have cancer at all but are diagnosed as such, and undergo treatment that isn’t needed. its not as clear cut as some here are painting it to be.

        • Certified Hamster Midwife

          [citation needed]

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth
          • Certified Hamster Midwife

            That’s the same thing I was talking about. By saying ‘treatment” you made it sound like doctors were throwing women on chemo for false positives.

          • Young CC Prof

            Actually, there are two different potential problems with positive mammograms. One is that only about 10% of suspicious marks on mammograms are actually cancer, but this is handled with ultrasound and biopsy. It is unfortunate that so many women go through the stress of a false positive mammogram, especially if the doctors worsen that stress by failing to explain that most positives are false positives. However, ultimately a biopsy does no real harm.

            However, the other problem is that about 20-30% of very small cancers detected by mammogram are not aggressive and would never have advanced to the point of causing harm to the patient. Currently we have no way of separating the rapidly growing cases of DCIS from the ones that will just sort of sit there for decades without hurting anyone. These women ARE harmed by overtreatment. (With prostate cancer, most very early cancers detected by screening are harmless. This is why authorities are urging that doctors stop screening men for prostate cancer, because the screening was actually doing more harm than good.)

            Now, in women age 50-70, those who get regular mammograms are at significantly decreased risk of death from breast cancer, so it is definitely still worth doing. But the over-diagnosis issue is one reason that mammograms in younger women are not recommended unless there is a strong family history or signs and symptoms indicate it.

            Also, yes, there is a miniscule radiation risk, which is more significant if you start, say, doing annual scans at 20 rather than 50. The final twist is that the scariest breast cancers are the very rare ones that strike young women and move fast. Annual mammograms would be useless against these cancers, they can go from undetectable in one scan to metastatic long before your next scan is due.

            Hence, get your mammograms if you are over 50. It’s show to help if you are over 50. Don’t do it if you are 35 unless there’s something wrong with your breast.

    • Box of Salt

      Lisa from NY “My anti-vax friend insists that mammograms CAUSE breast
      cancer. Is there any truth to this?”

      A mammogram is an x-ray of the breasts. http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

      Yes, there is a risk that an x-ray can cause cancer. Without looking anything up, I’d guess the risk is about equivalent to the risk of a serious adverse reaction to a vaccine. Need I say more?

      • Box of Salt

        To clarify for the science-challenged: the risks involved in getting both a mammogram and a vaccine are extremely low, but do exist. Because the risks are extremely low, the benefits (mammograms detect breast cancer at a stage when treatment is often beneficial, and vaccines prevent disease) outweigh the risks. By orders of magnitude.

    • Box of Salt

      Lisa from NY: does your antivax friend also refuse dental x-rays?

    • Trixie

      $10 says she’s never even tested her home for radon.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      There are recommendations that say the suggested schedule of mammograms is excessive and should be reduced. So, there is a little bit of truth to it. recent reviews have found that the risk outweighs the benefits.

      • The Bofa on the Sofa

        There are recommendations that say the suggested schedule of mammograms is excessive and should be reduced. So, there is a little bit of truth to it.

        This is wrong. As noted above, the biggest concern about mammograms is not that they cause cancer, but that they lead to false positives. The schedule is being reduced in areas where the fraction of false positives is the highest compared to the rate of true positives.

        The changing of the schedule has nothing to do with whether they cause cancer or not.

    • AlisonCummins
    • AlisonCummins

      See also:
      http://www.prevention.com/health/health-concerns/12-myths-ignore-about-breast-cancer/myth-mammograms-cause-breast-cancer

      Mammograms used to be able to cause breast cancer at a very low rate. These days the rate is so low as to approach zero. The risks of today’s mammograms are in overdiagnosis: what happens if you detect “something” that has a 20%–30% chance of being “nothing”?

  • sdsures

    “knitted with steel wool” LOL

  • Eater of Worlds

    Geeze, all those dogs with mammary cancer must be fucking afraid of the world.

    • fiftyfifty1

      They need to run in packs and eat raw meat. Then all would be well.

  • Trixie

    Dr. Amy, the Melissa Cheyney link seems to just redirect to your home page.

    • Amy Tuteur, MD

      Sorry about that; I fixed it.

  • wilifred

    Please, please, please, can we not use photos with bras that fit so poorly? I feel uncomfortable just looking at it. Signed, a 40 6g who has spent way the hell to much of her life in ill fitting bras.

  • C T

    A friend fighting breast cancer while pregnant (she’s about halfway through the pregnancy and just had a mastectomy) said that she was suspicious of breast cancer months ago and asked her family doctor about it, but he misdiagnosed her and told her not to worry about it, “adamantly reassuring” her that all was well. Later she brought up the issue with her OB/GYN, and the breast cancer was then diagnosed. Valuable time was lost in part because of this pervasive feeling that fear is always an enemy, when fear is often an important part of our defensive warning system.

    • Trixie

      Oh man. I can’t even imagine. I hope she’s on the road to recovery.

    • Elizabeth A

      My heart absolutely goes out to your friend. I hope that her pregnancy and her treatment go well.

      I have to say, though, I don’t think it’s a culture of writing off fear that causes these failures to diagnose. I, too, brought what turned out to be a cancerous lump to my PCP, and was told that it was a harmless cyst, only to have it later turn out to be cancerous. Breast cancer in younger women is comparatively rare, and often very aggressive when it arises. A few months or even weeks can make a dramatic difference to these cancers (my understanding is that HER2+ breast cancer has a doubling time of 3 weeks). So there are an assortment of factors: we tend to be less concerned about young women without known genetic risks factors developing cancer, the cancers those women develop can go from questionable to dramatic in very short periods of time, and we are biased towards accepting evidence of things we want.

      • Dr Kitty

        Even IF I think a breast lump is benign, I will offer to refer to the local breast clinic (a one stop ultrasound, mammography and biopsy clinic where you’ll get same day diagnosis) if the woman wants peace of mind.

        That way, she feels listened to, and if she decides not to go there, at least knows it was on the table.

        I wouldn’t generally be happy to diagnose an enlarging lump present for more than four weeks as benign on clinical examination alone unless the woman was adamant she didn’t want further investigation.

    • BeatlesFan

      I bet she’ll still run into sanctimonious assholes who belittle her for not being able to breastfeed, too. I hope your friend has a speedy recovery and a healthy baby. What a scary thing to go through during a time of joy.

  • Trixie

    OT but I ran across a new made up certification today: “Board Certified Holistic Health Coach”

    • Dr Kitty

      What are the certification standards?

      Surely that job just boils down to repeating “exercise more, a good diet means eating everything in moderation, don’t smoke, drugs are bad mmmkay, have you thought about therapy, yoga and tai chi are pretty cool, are your financial affairs in order?” on a loop.

    • Certified Hamster Midwife

      I’ve noticed a lot more health, wellness, weight loss, fitness, and specific disease coaches online. I think part of it is that lay bloggers on health topics get tired of answering questions that people are afraid to take to their doctors or that doctors dismiss, but still want to help people, so charging per hour for their advice is a good compromise. (Even Dr. Amy has, or had, a site where she charges for advice, because if you offer advice for free soon enough you’ll be doing nothing else.)

      • Trixie

        It turns out to be pretty quacky (see above).

        • Certified Hamster Midwife

          Well, that is not at all surprising.

    • Burgundy

      I saw on my FB today that an old college friend of mine is a “Board Certified Holistic Health Coach”. I haven’t talked to her for the last 3 years. (Ever since she moved to the dark side). Maybe I should find out what she is offering…..

      • Trixie

        Well, she’s at least $5,000 poorer….

        • Burgundy

          Trixie, I talked to my friend and she gave me a free “consultation”. It was a very woo-filled BS. She basically incorporated feng-shui and self-help stuff to “encourage the clients reaching their life goals”. She charges her clients $250 an hour! Man, I can see a Therapist for much less than that (well, insurance cover most of the fees). Then she complained that she could not sustain a long term client and how people don’t understand the long-term benefits of a life coach.

          • Trixie

            Oh dear. Isn’t feng shui just sort of a woo-tastic way of saying that sometimes it’s nice to move some furniture around and redecorate? Because I’m pretty sure interior decorators charge less than that.

          • Burgundy

            in the early days, it is the basic builder guide, like don’t block the entry way or don’t build a house by the mud-slide hill. Somehow over the last 1000 years, it evolves into a monster.

          • Trixie

            So it was basically just an ancient UCC?
            I do feel that my home is more harmonious when not being destroyed by a natural disaster.

          • Young CC Prof

            Indeed. I like the part of Feng Shui that says you shouldn’t build a house with a door facing north, because it’s bad luck.

            Actually, it’s just cold, being as they didn’t exactly have weatherstripping.

          • Trixie

            You know, I googled feng shui front door and was relieved to find out that I had chosen an auspicious color for the cardinal direction that my front door faces. I really can be a feng shui consultant!

          • The Bofa on the Sofa

            It’s comments like these that makes me lament the fact that I have ethics.

            The things people will pay for… (although, apparently, they aren’t willing to pay near as much as she’d like)

            Then she complained that she could not sustain a long term client and how people don’t understand the long-term benefits of a life coach.

            OR maybe they realize any benefits at all? Nah, that couldn’t be right…

          • Trixie

            You and I will team up for a first-of-its-kind placenta encapsulation and postpartum feng shui consulting service. For a mere $500, you get some fake placenta capsules that are really just dried beef liver, but in a fancy jar, and a complete rearrangement of your living room furniture to align with your personal chakras and aura and astrological chart.
            You’ll be the Bofa that moves the Sofa.

          • Burgundy

            I can read the “real” Chinese feng shui book, (or have a Chinese book with me walking around in a lay person’s house, they can’t tell what I have in hands) I will join the team and we can jack up the price to $1000.
            hahaha….

          • Burgundy

            Honestly, I can get the same thing from my close girlfriends for free. So I don’t see how her service can “enrich” my life.

          • Dr Kitty

            Sorry, did I understand correctly that your friend was bemoaning that fact that it is difficult to create a co-dependant relationship with someone who will pay for your advice, when your only qualification is having read a few self help books and knowing where to put the stickers on your mirror so all your Chi doesn’t get reflected away?

          • Burgundy

            Bingo! Although she insisted on that she went through training which qualified her to charge a high price. I found out that now she was anti-vax as well. I would never invite her family to any of my social functions. I have to protect my kids. She recommend her clients to drink at least 1 gallon of water per day and do ti-chi.

  • Elle

    “People in Africa don’t get skin cancer either, which clearly proves that sunscreen causes it.”
    -Kevin Trudeau (okay, rough paraphrase)

  • Young CC Prof

    There is this awful awful man with a clinic just down the street from me. He’s a medical doctor gone alternative, has no insurance arrangements or hospital privileges anymore. The thing he does that makes me HATE is “breast thermography,” where you try to diagnose breast cancer by looking at a heat image.

    It’s a bit more effective than random guessing, but far less effective than mammogram, ultrasound or physical exam, and it amounts to cancer quackery, which is, IMHO, the most vile and repulsive form of quackery. I really want that man run out of town on a rail.

    • Houston Mom

      I had wondered how quacky thermal imaging was. I heard a proponent of it on our local NCB radio program “Whole Mother.” It sounded plausible to me & a lot more comfortable than a mammogram. But I had some doubts about the woman advocating it when a male caller asked about the possibility of getting thermal imaging of a growth on his scrotum. He said his regular doctor refused to look at his “junk.” She told him the area was too warm for thermal imaging but could not think of what sort of specialist he should see about his problem. Neither could the midwife who hosts the show. The next caller told the midwife and guest, “Urologist.” She was thanked. He said the growth was shaped like Australia. I sincerely hope it was a prank and he’s ok but it was hilarious.

      • Young CC Prof

        Like I said, it’s shown to be more effective than random guessing, but it’s not effective enough to be useful. The FDA does NOT allow it to be promoted for cancer diagnosis, so it has to be advertised with wiggle words.

        And the scrotum is too warm for thermal imaging? That’s almost as nutty. I’m a little freaked out by a midwife who doesn’t understand the basic biological function of the scrotum, which is maintaining the testes at a LOWER temperature than the rest of the body to optimize sperm production.

        Then again, the midwife just needs to get the babies out. How they got in is someone else’s problem, I assume.

    • resaurus

      He doesn’t happen to also offer chelation therapy and a host of other bogus treatments, does he?

      • Young CC Prof

        I don’t think he does chelation, his bogus treatments at least appear nontoxic.

        • resaurus

          Phew. There is a doctor in my state who offers chelation, breast thermography, etc and doesn’t take insurance. In my previous work, it broke my heart to hear about this guy from a low-income client, using his services for her autistic child; she fully believed in what he was doing, as she paid him what little money she had.

  • Trixie

    I sure hope they’re vaginally knitting with the steel wool. Otherwise it doesn’t count.

    • http://kumquatwriter.wordpress.com/ Kumquatwriter

      OW OW OW OW OW OW OWWWWWWWW!

      • sdsures

        But…but…pain is GOOD!!!

      • Em lay

        But… Hypnoknitting! Orgasmic knitting! I can teach you how for a few thousand bucks

    • Guest

      Totally OT, but who the f#%£ would wanna wear the vagina scarf that woman’s knitting?! Ick!!

  • The Computer Ate My Nym

    All those charities in Africa are soliciting money for malnutrition,
    infant mortality, maternal mortality, and obstetric fistulas. Have you
    seen even one commercial for an African breast cancer charity?

    Um…actually, I have. ASCO is calling for volunteers to go to a number of less developed countries. Admittedly, none of their current programs are in Africa, but they have had in the past and will again.

  • Rochester mama

    I have a science question, if having babies and breast feeding protects women from breast cancer, why does it increase breast cancer in cats and dogs. I volunteer with animals and have seen many older females that have clearly had lots of litters with breast tumors. And vets always list that as a clear reason to spay pets.

    • The Computer Ate My Nym

      The short answer is I don’t know, but there is increasing evidence that having children and breast feeding is not universally protective in humans either. For whatever that’s worth.

      • AlisonCummins

        I think we knew that some women who have breast cancer were pregnant and breastfed. (In fact most, because most women have children.) So I think the increasing evidence is about something different?

        • The Computer Ate My Nym

          There was a recent study that suggested that Mexican women had an increased risk of triple negative (poor prognosis) breast cancer with increasing number of pregnancies and rate of breast feeding. Also, pregnancy after a certain age (30? 35? I can’t remember for sure) is no longer protective.

          • Certified Hamster Midwife

            The best protective effect comes from having children and breastfeeding before age 20.

        • Young CC Prof

          Having children and breastfeeding cuts the risk somewhat, on a population basis. I remember hearing 30%.

          This means an awful lot of women with children are still going to get breast cancer.

          • Trixie

            And the benefit to breastfeeding is cumulative, I believe. Probably to the extent that it suppresses estrogen? Which of course, varies. Some women will be exclusively breastfeeding with no pacifiers or bottles at 6 weeks and get a period. Others can nurse a toddler once a day and still not ovulate.

      • Elizabeth A

        Would you mind pointing me at that evidence?

        My breast cancer arose in the same breast that had chronic overproduction problems while I was nursing, and the original lumps were in the quadrant that had blocked ducts leading to my one round with mastitis. There are a lot of possibilities for the causality on that (maybe the blockages were signs of early cancer development, or of abnormalities in those ducts that made them more prone to cancer, maybe the mastitis made that area more prone to cancer, who the hell knows). I’d be really interested in any data that potentially commented on the relation.

        • fiftyfifty1

          I know this isn’t what you asked for, but breast cancer is most common where the breast tissue is most dense. That is usually the upper outer quad.

      • Dr Kitty

        The original hypothesis was based on observational data comparing breast cancer in nuns (higher) with married mothers (lower). I think the details still need work.

    • Trixie

      It’s probably not the number of litters so much as whether the animal was spayed before sexual maturity.

    • Stacy21629

      Short answer – dogs and cats are not humans.

      Long answer – mammary cancer cells in dogs and cats are predominantly estrogen responsive whereas (as I understand it) that is not the case in humans. In dogs and cats that are spayed prior to their first heat cycle, their lifetime risk of breast cancer is nearly 0. Spay between the 1st and 2nd heat cycle and it’s about 1 in 8, spay any time after the 2nd heat cycle and it’s about 1 in 4. However, only 50% of breast masses in dogs are malignant, compared to 90%+ of feline masses.

      Interestingly enough, if you spay a dog withOUT a breast mass at say 5 years of age and she later develops breast cancer her life will actually be SHORTER than if you had waited and spayed her at the same time as mammary mass removal later in life (assuming it’s caught as a “lumpectomy” and not a radical mastectomy and metastasis has not yet occurred).

      Anyway…more to the topic, I gave up trusting my breasts when my 2nd child was diagnosed failure to thrive at 4 months of age. I’m still glad to breastfeed her…but I’m even more happy about that bottle of formula that follows it. In less than a week I am already seeing a happier (and heavier!) baby and it thrills me.

      ~A formerly EBF, now supplementing veterinarian :)

      • Trixie

        Hey, I guessed right!

      • Rochester mama

        Thanks for the explanation.

    • Ainsley Nicholson

      I’ve read that the risk of breast cancer increases with every menstrual cycle. In humans, pregnancy and breastfeeding cause long-ish intervals where the menstrual cycle is interupted, thus reducing the total number of cycles over the course of a lifetime. In cats and dogs that are spayed, they remove the ovaries and so the number of lifetime cycles is reduced (or eliminated, for early spaying). Unspayed animals tend to have lots of litters, but they still have more cycles than spayed animals. We might predict that an unspayed cat or dog that was prevented from having any litters would have an even higher risk of breast cancer.

      • Stacy21629

        Actually, after the second heat cycle there is no change in the overall lifetime risk of breast cancer. In other words, whether you spay after the 2nd heat or the 20th heat, the odds are still the same – 1 in 4. Number of litters born or not born also has no effect. What does change (as I mentioned below) is the average lifespan depending on the spatial relationship between the time of spay and the development of breast cancer.
        However, there definitely is an increased risk of pyometra (life-threatening uterine infection) with an increased number of heats. So there’s still an incentive (and I believe a greater incentive) to spaying whatever the age (i.e. don’t wait until there’s a need for breast surgery to spay because it will increase the lifespan) – even if the dog has had multiple heats already because it avoids pyometra. Then just deal with any mammary lumps ASAP if/as they appear.

        • Ainsley Nicholson

          Thank you for the correction!

        • Young CC Prof

          Ah, the uterine infection. That happened to my ex’s family’s St. Bernard. She was a really beautiful healthy purebred and they wanted to breed her, so they didn’t spay her. Except seven years later, they still hadn’t gotten around to finding a suitable partner. Dog survived, after a hysterectomy, poor thing.

          That level of organization was about par for the course in that family.

          • Certified Hamster Midwife

            I actually had that happen with one of my hamsters.

        • Dr Kitty

          Our lovely Pyrennean had to be euthanised for uterine cancer at the age of 8.

          It wasn’t my parents’ choice not to spay her, as an 80kg giant breed the vet felt that the risk of the surgery was too high. Our next dog was a Lab/Alsatian mix that was spayed as soon as possible, and she lived until she was 13.

          My new cat was neutered as soon as he was 4 months old (the earliest my vet would consider it) and is currently a gigantic furry weight on my lap, trying to experience the touch screen for himself.

          One learns from previous mistakes…

      • Stacy21629

        (Hope this doesn’t double post…but I don’t see my original. Apologies if it shows up twice).

        Actually, after the second heat cycle there is no change in the overall lifetime risk of breast cancer. In other words, whether you spay after the 2nd heat or the 20th heat, the odds are still the same – 1 in 4. What does change (as I mentioned below) is the average lifespan depending on the time relationship between the time of spay and the development of breast cancer.
        However, increased number of heats does translate into an increased risk for pyometra, an life-threatening uterine infection that necessitates and emergency spay. So even if the dog has already had multiple heats and the breast cancer risk won’t change, it is still a good idea to spay to eliminate the risk of pyometra. Then deal with any mammary lumps ASAP if/as they appear.

      • Stacy21629

        Also, the number of litters born does not influence the risk of breast cancer either, I guess unless the dog was bred on the first heat and then spayed (so she doesn’t have 2 heats) – because, again, after 2 heats there’s no change in lifetime breast cancer risk no matter the number of total heats. Now, you shouldn’t breed your dog on the first heat anyway…so, take that with a grain of salt.
        Anyway, probably more than most needed to know. :)