In the past fortnight, I've learned some interesting things about my breasts. And unaccustomed as I am to featuring this body part in my written work, I was so foolishly surprised by some of them that I thought it worth sharing.
About six weeks ago, I turned 50. Apart from the other enjoyable entitlements that accrue to a lady on this milestone (an open carry licence for rogue chin hairs, heightened authority to dispense irritating advice to one's children, and so on), there is also a mild flutter of medical administrivia that comes due on this date.
Alongside the birthday greeting cards on the doorstep, for instance, plops the special bowel screening envelope, confirming that I've officially joined the age cohort among which bad things start to happen with increasingly regularity.
Also, it's time to have a federally funded mammogram.
I popped in to the nominated BreastScreen clinic in a western Sydney suburbs shopping centre on a Monday to have it done. What happens is you get your top off, and square up — under the close supervision of a mammographer — to a machine that is essentially a giant Jaffle iron. It squeezes your boob flat so that an X-ray can be taken.
By the way, there is absolutely nothing intuitive about the way to load yourself into this piece of kit. You have to sort of flop your boob in, then drape the corresponding arm over the machine, then look to the other side and raise your chin, while dropping the relevant shoulder AND keeping it relaxed AND holding your breath.
There is no human activity that ordinarily demands this precise body position, apart from "breaking into a house by reaching through a side window next to a door in whose letter flap you've accidentally got your breast stuck, while simultaneously watching out for birds of prey".
Mammograms: not just for women over 50
Once you're in, the mammographer scoots back to the control panel and ratchets the Jaffle down so as to render escape impossible, or at least visually amusing.
It didn't take long, though. I was out of there before I knew it, free as a normal bird and armed with the certainty that I was, for once, up to date with my self-care obligations.
Two days later, by coincidence, I moderated an online session on breast cancer treatment and side effects for the research organisation Breast Cancer Trials.
My sister-in-law is a breast cancer survivor, and several people dear to me are currently in serious biffo with other types of cancer, so I'm always keen to get better at understanding.
In this session, there was a survivor participant who was diagnosed at 38.
Naveena went for a mammogram on Christmas Eve after seeing her doctor about a raised lymph node, and mentioning that there was a lump in her breast which kind of came and went. She hadn't taken the symptoms all that seriously for a while, reasoning that she was not yet 50 and as such not really at risk of breast cancer.
One of the oncologists on the panel said he heard this a lot; that he regularly saw women under 50 who postponed seeking advice on lumps or symptoms because they thought themselves too young. And with a jolt, I realised that I fit into this category too; I do the self-examination thing in the shower but am always acutely conscious at these junctures that I'm in less-than-expert hands, if you know what I mean. And I've always thought of mammograms as a post-50 thing.
But of course, I smugly thought to myself, I already had a mammogram two days ago! So that's all under control.
And it was, until I got the text the next morning.
An area of concern
"Annabel, could you call Ruth at BreastScreen please regarding your recent mammogram. Many thanks."
I was about to step into a radio studio for an interview when that popped up. So, for the next half an hour or so, half of my brain was occupied with the evolution of local retail from 1850 until the present day, and the other half was worrying about whether anyone would remember to provide gluten free options at my wake, for my coeliac friend Miranda.
Later that day, I finally managed to talk to Ruth, who was very reassuring, explaining to me that while there was an "area" on my right breast that had triggered some concern, it was quite possibly just a natural feature of my physiognomy. It was quite common, she told me, for women to be called back after their first mammogram, because analysts had nothing to compare the image to; no way of knowing whether a shaded area was a new thing or had been there for ever.
This would probably have been a good thing to know at the time I went in for the screening, but certainly Ruth communicated it well.
Plus, she said, more broadly one in 20 women get called back after a mammogram. And in 90 per cent of those callback cases, no cancer is found.
We made an appointment for me to go to the Royal Prince Alfred Hospital, where four or five hours could be required for further tests.
As I waited for the appointment to roll around, I developed private theories about what might have happened to my right breast. It had a fierce bout of mastitis in 2013, when I made a full series of Kitchen Cabinet while toting around a three-month-old baby who refused to be anything but breastfed.
We were filming in Adelaide with Nick Xenophon, whose natural garrulity and low-to-moderate kitchen skills meant that he took several hours to make tzatziki.
By the time we sat down to eat, it was well after dark and I needed to feed the baby, but we also needed to complete the shoot. I started to feel hot and strange. If you look at the raw footage from that shoot, you can actually SEE my right breast inflating like an angry red balloon. The baby, by the way, was annoyed but okay. But that boob has never been quite the same since.
Another sandwich press, a BreastScreen smock
When I arrived at the RPA's breast scan centre, Ruth brought up the scans on her screen and indicated areas of my right breast that seemed to be the cause for concern. "There's a lot of light area, but also there is a sort of star shape here... do you see it?"
I did not see it. As I gazed at the hectic black and white cross-hatched cirrocumulus image on the screen that was my right breast, and tried unsuccessfully to see the star shape Ruth was talking about, all I could think of were one-liners that would be inappropriate to say aloud.
Like: "All I can say for sure is that if you live in Newcastle, take your washing off the line!"
Or: "I don't know, Ruth. All I can see here is my parents having sex. Is that bad?"
Ruth explained that today would involve an additional mammogram, this time in a 3D machine. Then an ultrasound, where a radiologist could have a good look at the tissue inside my breast.
And if they found anything that looked worrying, they might then take a needle biopsy; Ruth was kind enough to present this as a distant possibility, rather than a sure thing. "Do you have any allergies?" she asked.
"Not really. I mean, I'm not massively keen on having needles stuck into my boobs, but I'd be surprised if that qualifies as a formal allergy."
I was then delivered into the friendly hands of Aoife, who invited me to take my top off and manoeuvred my breasts one at a time into a large sandwich press that to the untrained eye seemed exactly the same as the one from last time.
Why were we doing this again? Well, turns out that the 3D machine is different from the first one; it can see more, and you can fiddle about from different angles so as to get a better look at anything that's potentially dodgy.
It was over pretty quickly and I was handed a BreastScreen smock to put on instead of my clothes, and returned to the waiting room.
Was it cancer?
Ten minutes later, I was retrieved by Miriam, who explained that she was going to conduct an ultrasound scan of my troublesome orb.
She squirted a generous amount of warmed gel (yes, warmed! Perhaps it's the shadow of mortality that prompts this thoughtful courtesy, offered to no pregnant woman ever, as far as I know — though to be fair I always had my kids on the cheap) on the affected area and then rubbed it all over my right breast for a full five minutes, while I lay there unsure of the right degree of a) conversation and b) eye contact that's appropriate when you're getting to second base with a medical professional within 90 seconds of meeting her.
Finally, she said: "Look, I'm happy with your mammogram. I don't see any evidence of cancer. The issue here is that you have dense and difficult breasts."
Obviously, any person who has ever been female in a public place is aware that mammary glands can occasionally attract mixed reviews.
But this was a bit of a jolt. Dense? Difficult?
I pictured my boobs struggling to comprehend trigonometry, or demanding to see the manager in a homewares shop.
But as Miriam patiently explained, it's more about tissue. Fatty tissue is less dense, and on a scan it looks dark. A breast that is higher in fatty tissue is easier to scan because cancer will show up as white and be quite noticeable.
My breasts, it turns out, are heavier on the dense glandular and fibrous connective tissue. This also shows up as white, which is why my breast scan looked like a Bureau of Meteorology prediction of rain. And why it was hard for analysts to tell — especially since this was the first image available to science of this particular mammary gland — whether the white stuff was cancer or just tissue.
So I packed the dense items back into my clothes and thanked Miriam and the rest of the team, and sailed out of there. Cancer free, as are the vast majority of mammogram recipients, but a bit smarter about my own boobs.
