Mammography: why is it so difficult to decide on it?

Marina was 42 years old when the therapist, to whom she turned with a cold, insisted that she also undergo a mammogram, as doctors advise at this age. “I carried a referral in my bag for a whole month,” recalls Marina. – A mammologist works in the same clinic, but I did not find time to visit. It seemed to me that the 40th anniversary and mammography are connected purely symbolically. Once I even made an appointment, but I never got to the doctor. I just didn’t have time.”

Who can boast of knowingly and regularly undergoing a medical examination? Only 32% of Russian women visit a mammologist at least once a year, a doctor who diagnoses, treats and prevents various breast diseases. 38% are examined much less frequently. Almost a third of those who do not visit a doctor, like Marina, explain this by the lack of free time, 41% say that nothing bothers them and they do not see the need for a medical examination, and 4% are sure that they are still too young to be diagnosed breast cancer*.

It is difficult to decide on a medical examination when we are not sick – this is recognized by all our experts. But breast cancer is a special disease, it ranks first among malignant neoplasms in women. “Healthy cells are transformed into cancer cells, and this process is asymptomatic in the early stages,” says Sergey Prokopenko, oncologist and general secretary of the Russian Association of Mammologists. – You can only notice it with the help of mammography. When a doctor, examining a patient, detects even a small tumor (1,0–1,5 cm in diameter), this means that it has been developing in the body for several years. And with the help of mammography, it could be noticed much earlier, and treatment could be started earlier.”

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It only happens to others

“This can never happen to me!” – according to doctors, this is exactly what many women think, refusing preventive diagnostics. “The unconscious fear of hearing a diagnosis that will change life forever can be so strong that a woman begins to involuntarily deny the very possibility of getting sick,” comments oncopsychologist Olga Rozhkova. “Her psyche is protected by an unfounded optimism.”

Refusing to be examined, many behave like children who believe in a fairy tale: nothing bad can happen to them in it. “Our psyche, with the help of a regression reaction, “returns” us to childhood and thus temporarily protects us from anxiety and fear,” explains psychoanalyst Svetlana Fedorova. – By not daring to undergo a mammogram, women maintain a childish narcissism in themselves, the belief that they are omnipotent and invulnerable. By clinging to their ideal self, they try to avoid a situation that could result in a frightening diagnosis.

On the contrary, the decision to undergo a timely examination becomes an inoculation against narcissism. “After all, at this moment we accept the limitation of our omnipotence and at the same time recognize independence from some higher powers, deprive them of the right to control our lives,” the psychoanalyst explains. “The willingness to take care of oneself, one’s health is the conscious position of an adult.”

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For the sake of loved ones

It seems that women, unlike men, are more attentive to their bodies. From adolescence, they visit a gynecologist, and later regular consultations with a doctor cause them less inconvenience. “Nevertheless, many Russian women treat themselves “according to the residual principle,” Olga Rozhkova states with regret. “Even when making an appointment with a doctor, they often miss it, they just can’t find the time: either the son takes exams, or they don’t let go of official duties.” The decision to undergo an examination is made only when a tumor is suspected, which a woman perceives very painfully – as a threat to her life plans, the well-being of loved ones, as a loss of control over her life and the collapse of her career. “I try to explain to patients that right now, when they are full of strength, you can take care of yourself and your loved ones by doing a mammogram,” says mammologist Irina Vasilyeva. Many women decide to undergo an examination precisely for altruistic reasons. “Of course, this procedure is unpleasant for me, I feel embarrassed when my breasts are placed between x-ray plates, but I want to keep my children and grandchildren healthy,” admits 55-year-old Maria. And yet, over time, many women become fatalists. “Come what may,” sighs 68-year-old Svetlana. “What will this examination give at my age?” In such a situation, much depends on the doctor’s contact with the family. “The presence of relatives is important for older women, who can confidently explain to them that diagnostics are necessary at any age,” says Irina Vasilyeva.

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Control and freedom

For some women, refusing to be examined is part of their life strategy, Svetlana Fedorova believes. “There is also something of archaic thinking in it: cancer is like an omnipotent mother who has the right to complete absorption. No wonder they say about this disease: “devours”. We cannot see it, and this uncertainty awakens deep archaic fears, including the fear of castration, that is, the fear of losing power over one’s own life, losing freedom, losing oneself. Women are often afraid to even think that they might get sick, lose an important part of themselves, lose their gender identity, lose their breasts. This is how an unconscious and, at first glance, unfounded reluctance to undergo a mammogram is born.

“I no longer worry about cancer, because now I lead a healthy lifestyle,” says 45-year-old Nadezhda. – I moved out of town to a wooden house, planted a garden and eat only my own vegetables. I only come to the city for group yoga classes and I never miss them.” But Nadezhda regularly misses her annual visit to the mammologist, as she is sure that her lifestyle protects against diseases. “The referral for examination is perceived as a reminder that we are mortal,” Svetlana Fedorova comments on Nadezhda’s story. “It threatens our will to live, so many people want to shut themselves off from it.”

Right not to know

The tests set off a chain reaction of anxiety. Patients know that good results are not a guarantee of health, they know that doctors will tell them that everything is fine now, but in two or three years they will need to be examined again. It is especially difficult to come to terms with the need to prevent relapses in patients with experience.

The choice of 35-year-old Alexandra is to forget about the disease so as not to lose the desire to live. After all, she has a genetic predisposition to cancer. “Doctors constantly tell me about the need to regularly monitor the state of health. But how can I feel safe thanks to the examinations if death has stuck to my DNA? she says bitterly. “I lead a group of women who have a mutation in the genes responsible for breast cancer,” says Irina Vasilyeva. “The despair of many of them is difficult to put into words. “Perhaps I should have both breasts removed?” one of the women asked me. After all, if there is no breast, there is no problem.

So maybe it’s better not to know? To be a free person means to have the right, among other things, to ensure that life remains unpredictable. “Respecting the patients, oncologists tell them about the meaning of the examination, encouraging them to do mammography,” says Irina Vasilyeva. “If a woman feels that the attending physician cares about her fate, it is easier for her to overcome her fears.”

“And make the right decision,” adds Galina Korzhenkova, a mammologist and chief expert of the Avon Together Against Breast Cancer program. – Over the past two years, the number of women who trust the results of mammography has increased by 15%. And that’s a good result.”

* According to the GfK Rus Marketing Research Institute, commissioned by Avon, 2011.