You read that correctly. According to the Utah Department of Health’s Public Health Indicator Based Information System (IBIS), the number of woman who have had a mammogram within the past two years trails the national average by 7.8%. While the national average of 72.3% isn’t something to brag about, the Utah rate of 64.5% leaves us wondering, “What’s up, Utah?”

Mammograms can be awkward. Honestly, signing up to have your breasts smashed between two plates in front of a stranger is, well, awkward. And there’s also the toll of increased anxiety about potential cancer, confronting your own mortality, and finding time in your already busy schedule. To be sure, these are all real concerns, but they don’t change the fact mammograms are currently the best way to detect breast cancer.

Mammograms can find cancerous deposits years before a lump can be felt. And finding cancer early is the key to survival. The five-year survival rate of early stage breast cancer is 99%. The five-year survival rate for late-stage breast cancer is 26%. Since the 1989, deaths from breast cancer have steadily decreased. Early detection methods and advanced cancer treatments continue to improve outcomes for people with breast cancer. So why are some people resistant to mammograms?

To help figure out why Utah women aren’t getting recommended health screenings for breast cancer, the Utah Department of Health spoke with women in line at the Department of Motor Vehicles. I spoke with Joelle Fierro, the Cancer Control Communications and Media Coordinator at the Utah Department of Health, and asked her about the research. According to Fierro, the reasons women gave were varied and largely mirrored the big 11 items most researchers discover, including the typical comments about convenience, costs, and the mammogram procedure in general.

What follows is the listing of 11 items and some responses to specific concerns. All concerns are valid, and most concerns are reduced or eliminated with more information, more understanding, and more consideration. Especially for women receiving their first mammogram, information and education is useful for reducing stress and anxiety.

Utah also had two items outside of the normal concerns, one related to breast implants and mammography and one related to modesty and mammography. Those are covered in more detail following this list of 11 common concerns with mammograms:

1. I am afraid to have a breast cancer screening because I might find out something is wrong.  It’s a legitimate concern. At least part of the explanation for women’s anxiety about cancer lies a century of cancer public health campaigns. For decades we’ve been reading about breast cancer, something almost uniquely female (men get breast cancer, too, but only about 1% of cases), and American women tend to overestimate their risk of dying of breast cancer. Cancer is rare. Finding cancer early is important to successful treatment rates. That’s why recommendations are for regular screenings.
2. I am afraid to have a breast cancer screening because I don’t understand what will be done. Uncertainty creates a sense of anxiety. That’s typical. If a picture is worth a thousand words, then this video of a woman receiving her first mammogram should help you understand the process. A mammogram tech will help you position your breast in a mammogram machine, take some low-dose x-rays of each breast, and show you the results. Seriously, watch the video. If you have more questions, talk to the scheduler, talk to the receptionist, talk to the technician, or talk to your physician. Thoughtful caregivers will help answer your questions all along the way.
3. I don’t know how to go about getting screened for breast cancer. Getting a mammogram is the best way to rule out breast cancer. Most mammograms find no cancer, and as a result women who get regular mammograms have less anxiety and less concern over having breast cancer. Getting screened takes a couple of hours, though the mammogram itself takes just 20-30 minutes. Every Intermountain hospital can perform a mammogram. Find a hospital near you and go.
4. Getting screened for breast cancer is too embarrassing. There’s no getting around this one. It can be a bit awkward, and it creates about as much joy as a trip to the dentist. But getting a mammogram is more private than some people imagine; it’s just you and your mammogram technologist (unless you want to bring someone with you). And while mushing a breast between compression panels is awkward, it’s the best method available for finding breast cancer.
5. Getting screened for breast cancer takes too much time. It does take time. Most people plan for 90 minutes. Bringing a book to read, a phone to text from, or a game to play can help you feel like the time is passing faster. You’ll have some time in the waiting room, and then you’ll get changed into a hospital gown top. From there, the actual mammogram takes only 20-30 minutes. The results from the low-dose x-rays come quickly after that.
6. People doing breast cancer screenings are rude to women. This may have been true years ago. Technology was still developing, and the patient experience wasn’t optimum. But today’s women’s centers and hospitals are geared toward making the experience better for women. Mammogram technologists have specialized training to help you through the process. Your results will be sent to your physician within a few days to a week, providing you with quality one-on-one time with your caregiver.
7. Getting screened for breast cancer exposes me to unnecessary radiation. Getting a mammogram does involve low-dose x-rays. Since the 1970s, the dose of radiation has decreased and image quality has increased. Remember that natural radiation is all around us. Uranium from the earth and sunlight from the sun both contribute to background radiation. A mammogram only exposes you to radiation about equal to what you’d get from background radiation over a few weeks. The benefits of early detection and treatment outweigh any possible harm from the low-dose radiation.
8. I cannot remember to schedule a breast cancer screening. You’re not alone. Men don’t remember to get physical examinations, and we all put off going to the dentist from time to time. Consider associating your birthday month with getting your mammograms. It’ll be a reminder that you’ve got years of good health in front of you as you take care of your body.
9. I have other problems more important than getting screened for breast cancer. You’re the best judge of your health and your schedule, but if you can’t find time for a mammogram once a year, your life is probably a bit unbalanced. Making time for your health is good for you and the people around you. And once you get it done, you get the satisfaction of crossing it off your yearly to-do list.
10. I am too old to need a routine breast cancer screening. This could be true. There are different screening recommendations for women of different ages, but getting a mammogram is a consistent message - if you;re over 40 and in good health you should always get a mammogram. Talk to your physician about your specific health needs.
11. Getting screened for breast cancer is too painful. Compression is necessary to get the best imaging from the x-ray, so there is some discomfort, but today’s technology makes getting a mammogram more comfortable than it was years ago. But as you can see from this video of a mammogram, it’s not painful. Uncomfortable, yes, but not painful. One recommendation is to schedule your mammogram a week after your period when your breasts are usually less tender.

Concern #1: I’m Concerned About Having a Mammogram Because I Have Breast Implants. Does screening differ if you have breast implants? Yes, it does. It means a couple more x-rays on each breast, so it’ll take a few more minutes to complete the mammogram. Silicone and saline implants also make x-rays less clear, so make sure to tell your mammogram technologist about the breast implants before the exam. It will help them do their job better.

Can a Mammogram Cause a Breast Implant to Rupture?

Some people are worried about an implant rupture from the mammogram. While rupture has been reported from a combination of early-generation breast implants and excessive force, modern technology makes it very rare. Breast implant technology has improved; current implants are markedly safer than previous versions. Mammography equipment, too, has improved in the past few decades to reduce the force of compression. While you should definitely mention your breast implants to your mammography technician when scheduling an appointment, implants shouldn’t keep you from getting a mammogram.

Does Insurance Cover Mammograms if I Have Breast Implants?

Generally speaking, yes, you’re covered. We reached out to Brittainy Harris, a Compliance Consultant with Utah’s largest health insurer, SelectHealth. She confirmed that mammograms are covered once a year for every woman over the age of 18. It’s part of SelectHealth’s preventive medicine coverage. The only time she could think of when a mammogram wouldn’t be covered is if the breast implant has already ruptured, because then it would be a diagnostic procedure instead of a preventive procedure. “Preventive services are always covered,” Harris said.

Concern #2: Having a mammogram would require me to do things inconsistent with my faith. This question is tricky because the Utah Department of Health didn’t ask for religious preference when conducting the survey. In Islam, Catholicism, Judaism, Mormonism, etc., religions often teach principles of modesty, including a call for clothing that covers the body. Because of the variations in orthodoxy, some adherents cover their ankles and wrists while others cover their elbows and knees, and others cover their head. Think of a Catholic nun’s habit, a Muslim woman’s hijab, or a Jewish woman’s tichel. To billions of women, modesty matters.

Modesty, Culture, and Mammograms

From the perspective of most major religions, healthy diets are promoted, regular exercise is encouraged, and medical treatment should be sought after. The best ways to accommodate for modesty concerns during a mammogram are to take extra care before and during the appointment. While not every accommodation can be granted, most can. This helps make getting a mammogram easier and reduces anxiety.

Typical suggestions to safeguard modesty include:

• Female OB/GYN and Technician. All mammography techs are women in Utah. This can help you feel more comfortable to ask questions and to bring up any concerns you may have. Healthcare is designed to help customers
• Request Someone of Your Own Religion as Your Physician. It may not be possible in all locations, but if you know of a physician at your local synagogue, mosque, or church, they may be able to fit you into their schedule. It never hurts to ask. All Intermountain caregivers are sensitive to patient needs and patient requests, so they’ll do their best to make you comfortable.
• Bring a Chaperone, a Close Friend or Family Member. Having a simpatico in the waiting room can make having a mammogram more comfortable. They can chat with you if there is a wait, and can go out to lunch with you when the exam is over. That can make the experience easier and more comfortable for many people. You might even consider scheduling your mammogram at the same time as a friend so you can be there for each other.
• Take Your Own Clothing to Wear Instead of a Healthcare Gown. Wearing something from your own wardrobe can create a sense of familiarity. Your favorite pajama bottoms can make you feel more comfortable during the exam and give you more control over the situation.

Understanding Mammography Concerns

To better understand, I spoke with Layne Sybrowsky, the Director of Client Services for Deseret Mutual Benefit Administrators (DMBA), the non-profit organization created to design and administer employee benefits plans for companies owned by The Church of Jesus Christ of Latter-day Saints, including the Church’s for-profit entities such as Bonneville International, Deseret Book, and AgReserves.

He wasn’t surprised that most people don’t get the preventive screenings they can. He understood the constraints on time and awkwardness. He was also glad financial concerns didn’t show up as a prominent issue. “DMBA encourages women to take control of their health through regular health screenings, including mammograms,” Sybrowsky says. “Our health plans were designed to provide comprehensive benefits for preventive-care initiatives even before such coverage was mandated by the federal government.” 

Finding cancer early when it’s most treatable is one of the best ways to protect your health. “The Utah Department of Health encourages women 40 and older to talk with their doctor about getting screened for breast cancer, regardless of their family history,” said Fierro.

When asked about the frustrations of getting a mammography, Fierro was empathetic and understanding, then repeatedly mentioned the takeaway message: “Mammography is the single best way to find cancer early, when it most treatable. Simply put: mammography saves lives.”

If you have a family history of breast cancer, are over 40, or you or your physician thinks it’s a good idea, take the advice of Fierro, “Just go. Get a mammogram.”