Published Nov 30, 2021
Alexandra Shulman, 63, writes that she began to feel pain in the area of her breasts during the lockdown and decided to be examined by her doctor when it became too difficult to schedule a screening due to new protocols adopted at the height of the pandemic.
Her doctor reassured her that some inflammation near the rib caused her this pain, but having witnessed her younger sister battle the disease, Shulman asked for a referral to see a breast cancer specialist.
That decision may have saved her life.
In the weeks between her two appointments, Shulman had gone on holiday and all but written off any chance that she would soon be facing a cancer battle.
“I began to wonder if the pain was stress-induced – even though I had no obvious stress other than not being able to figure out the right subject for a new book. Perhaps I should cancel the appointment?” she writes of her mindset at the time.
“So it was in a thoroughly ‘It’ll all be fine’ state of mind that I walked into the Princess Grace Hospital in Marylebone that bright autumnal day, having first dropped into the nearby Bella Freud shop and toyed with buying a silk dress for the party season.”
She did keep the appointment.
Shulman quickly got some reassurance at her appointment when the specialist and a mammogram failed to detect cancer.
Out of precaution, Shulman was asked to have an ultrasound scan. Doctors discovered the painful growth she complained of and soon after diagnosed her with breast cancer.
“A biopsy followed right there to test what she had seen, and then I was back in the professor’s office, to be greeted with the news that yes, there was a tumor, relatively small,” recalls Shulman. “Because of where it was located, deep under the breast on the muscle of the rib, it hadn’t shown up on the mammogram.”
To start her treatment, Shulman caught the cancer early enough to undergo a simple lumpectomy, which doctors believed would successfully remove her cancer.
“The next results brought the fantastic news that the lymph nodes were clear – there was no spread,” writes Shulman.
“I met my oncologist, Prof Schmid, who said the magic words that I no longer had breast cancer. It was gone via the surgery. But further genomic testing would help determine whether chemotherapy would be advisable to prevent recurrence within ten years.”
Shulman also avoided chemotherapy after doctors determined the risk outweighed any possible rewards.
She celebrated by buying that dress she saw before her first appointment.
During the mammogram screening, the doctor looks for lumps in the breast tissue or early signs of breast cancer. The American Cancer Society (ACS) recommends women begin screening for breast cancer at 45.
Dr. Connie Lehman, the chief of Breast Imaging Division at Massachusetts General Hospital, said in a previous interview, “If you haven’t gone through menopause yet, I think it’s very important that you have a mammogram every year. We know that cancers grow more rapidly in our younger patients, and having that annual mammogram can be lifesaving.”
“After menopause, it may be perfectly acceptable to reduce that frequency to every two years,” says Dr. Lehman. “But what I’m most concerned about is the women who haven’t been in for a mammogram for two, three, or four years, those women that have never had a mammogram. We all agree regular screening mammography saves lives. I want to be completely clear. If you are between 50 and 74 and you have not had a mammogram in the last two years, you are overdue. Please get a mammogram.”
The Protecting Access to Lifesaving Screenings (PALS) Act was reintroduced by Rep. Debbie Wasserman Schultz (D-FL) and Rep. Congressman Fred Upton (R-MI) in the House and Sen. Dianne Feinstein (D-CA) and Sen. Marsha Blackburn (R-TN) in the Senate.
If passed, the bill would guarantee free mammograms at least once a year to all women 40 and over.
This bill comes about as the current law allowing women age 40-49 breast screening coverage and free mammograms expires on January 1, 2023.
The U.S. Preventative Services Task Force (USPSTF) rates mammograms a C for women in the 40 – 49 age range, meaning that they do not recommend annual screenings. That is at odds with the recommendations of the American College of Obstetrics and Gynecology, the National Comprehensive Cancer Network, the American College of Radiology/Society for Breast Imaging, and many experts in the field of oncology.
“The notion that breast cancer is a risk only for older people puts young women at risk of not getting a screening that could save their lives. The USPSTF guidelines would exacerbate this problem by discouraging women from getting potentially lifesaving mammograms and putting them at risk of losing insurance coverage for screenings,” said Rep. Wasserman Schultz.
“As a breast cancer survivor who was diagnosed at 41, I know firsthand the importance of ensuring young women have access to the tools and information they need regarding their breast health. That is why I am proud to reintroduce the PALS Act with Congressman Upton, which extends the moratorium on these ill-advised guidelines and is supported by leading clinical and advocacy organizations.”
Dr. Stamatia Destounis, chief of the American College of Radiology Breast Imaging Commission, also voiced her support for the bill and spoke about how these screenings were more important than ever at this time.
“On the heels of a pandemic that kept many women from being screened for breast cancer, women now need greater access to screening, not less. Extending the PALS Act protections will avoid a needless decline in screening and thousands of unnecessary deaths each year as a result of implementation of the ill-advised 2016 United States Preventive Services Task Force (USPSTF) recommendations,” said Dr. Destounis.
“Women in underserved areas could be particularly hard hit if the PALS Act protections are not renewed. We urge all members of Congress to support the PALS Act.”