For many women, getting a mammogram is a mental health trigger

Screening is framed as self-care. But let’s acknowledge the anxiety, too.

October is Breast Cancer Awareness Month.flik47 - stock.adobe.com

October is Breast Cancer Awareness Month. According to the American Cancer Society, about 287,850 new cases of invasive breast cancer will be diagnosed in women this year throughout the United States. About 51,400 new cases of ductal carcinoma in situ (DCIS) will be diagnosed. About 43,250 women will die from breast cancer — and it accounts for roughly 1 in 3 of all new female cancers each year.

This week, Katie Couric went public with a breast cancer diagnosis (after a skipped mammogram) and urged other women to get checked. I appreciate the sentiment that propels women to share photos of themselves getting mammograms, urging others to do the same. It is absolutely essential. It is important. But I’d also like to talk about what happens behind the scenes and behind the hashtags.

For many women, it’s not as simple as heading out to get squished and screened. There are 264 million people worldwide with anxiety disorders; more of them are women. Lost among the (very necessary!) messaging about the importance of screening and mammograms is the fear. The panic. The concern that a finding — maybe a false positive! — will set off a cycle of callbacks and biopsies that can turn an ordinary life into one spent refreshing test results and Googling for a few days, weeks, months. Or, worse, the concern that a mammogram will turn up something devastatingly frightening and upend someone’s security with a phone call. These very real emotions can make many people, including me, just plain reluctant to take the next step. Is this fatalism at all rational? Maybe not. Is this real? Very.

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Yes, you might think that breast cancer statistics would have me rushing in to get a mammogram. Instead, I’m terrified of the wondering, waiting, worrying, and the potential to cross over from blissfully unaware to marked, with a timeline on my life. I’m afraid of sitting on the sidelines at soccer pretending to focus, bracing for a cold, clinical radiology report to arrive in my patient portal. I’m dreading a call from an unknown number blindsiding me at dinner. I’m afraid to get sick, and I don’t want to die. That’s the irony: Anxiety about our health can actually undermine it.

And I know I’m not alone: I write a lot about anxiety — health anxiety too — and, when I do, so many people crawl out of the woodwork to share their stories: of self-diagnosing, of Googling mysterious lumps, of being unable to focus at work because of a sinister bump, an angry rash, a persistent headache, or a trip to the ER due to irregular heartbeats. There are Facebook groups with tens of thousands of women posting about this fear every week; there are Reddit forums devoted to mammogram reluctance. Health anxiety is legitimate, but it’s also mixed with shame: After all, people with anxiety know that there are actual patients fighting cancer with courage. We can’t bring ourselves to get a mammogram? C’mon.

Meanwhile, a lot of the messaging around breast cancer awareness centers on putting your health first, as an act of self-care, as though women who postpone are martyrs who won’t take time for themselves. But, for women like me, self-care doesn’t have anything to do with it: I would gladly take time out to go to the dentist, because I’m not going to leave a cleaning wondering if I have a tumor. Women who don’t get mammograms aren’t necessarily afraid that it will hurt or too busy to do it. Many of us are afraid to confront our mortality, relinquish control, and make peace with uncertainty for a few minutes, hours, days, or longer.

This is a skill. It’s part of being an adult, really, to accept that life is uncertain. Breast cancer isn’t a soccer schedule or a carpool routine that we can mastermind, orchestrate, and design. For those of us with anxiety, accepting this hard and necessary truth doesn’t come easily. So I’m writing this for women like me, who care about their health — care about it so desperately that they’re afraid of having their sense of security shaken or shattered.

Of course, you either have cancer or you don’t, whether you know it or not. And it’s far better to know, and to know early, than to hide from the truth until you can’t ignore it. But, as Breast Cancer Awareness Month begins, I want to acknowledge the women for whom getting a mammogram isn’t as simple as making an appointment.

As for me? I’m making that call. I’m going in. I’ve strategized my way through it — how I’ll occupy my time waiting and what I’ll do to distract myself during the limbo. And I’m reminding myself that many offices read results right away because they understand the stress, and the chances are high that I’ll know immediately that everything is fine. And, if it’s not? I’d rather know and focus on the countless women who came out the other side as survivors. So consider this my mammogram PSA for the nervous, anxious, and scared. I know how it feels: You want to preserve your life at all costs. Tough as it is, this is the best way to do it. We’re in it together.