A man walks into a Mammography room. He’s told to drop his trousers and place his penis onto the X-ray plate. The radiographer gently pushes the man closer to the machine to ensure that his penis is isolated from his body mass, then brings down the upper plate to compress it. She does this little by little, until the organ is squashed flat and the man cannot move. The man says, “Oi! Tits first, I’m not a slag”.
You probably need to have been (like me) a teenager in the 1970s to appreciate that punch line, but women of all ages will recognise the set-up. The scenario itself is no joke - make the patient female and you have an everyday occurrence. Each of my mammogram experiences has led me to dread the next one; many women never return for another because the experience was too uncomfortable, even painful, yet the concept of sandwiching warm, soft flesh in cold, unresisting metal remains unchanged. Has anyone (like me) ever wondered what might happen if there’s a power cut mid-session? Can no-one come up with a better way to Spot The Tumour?
My mammogram last week was the usual tiptoe into pain. Doesn’t last long, doesn’t do any harm (unless you count the effect of radioactive waves surging through my breast tissue), so why make a fuss? I asked the radiographer what she would design if there were no precedents, just a brief to detect breast cancer. Something bowl-shaped, something formed from a gel-like material, something that could take a 3D rather than a 2D image? (I discovered later that the latter already exists as tomosynthesis but this still requires the patient to be clapped in irons.) Disappointingly, she explained that splaying boobs on a flat surface and then crushing them with another was the only way to secure a good image. Her expert stance was to stick with what she knew rather than to innovate.
Mammography, the medical imaging of breast tissue via X-ray, is used in public health as an initial triage tool, being the cheapest way to filter out potential cancers across a large population. Anything unusual is then viewed in more detail (and comfort) via ultrasound or MRI, though this step up to First Class is unlikely to be fully enjoyed by anyone nervously grasping their recall letter. Both of these next-level diagnostic devices are less harmful than X-ray but generally more costly in terms of time or money for en masse - let’s call it proletariat - screening. I doubt that the royal bosom has ever been subjected to the Breville Toastie treatment.
It’s actually easier to image tumours in older breasts, because menopause reduces mammary fat content (hence your nanna’s tennis-ball-in-a-sock look). The sheer density of younger breasts makes it harder to identify micro-calcifications and can lead to false negative results, which is one of the reasons for the post-50 age of women targeted in the UK’s screening program. Since this tends to be the section of female society who just sigh and get on with it (job, housework, kids, ageing parents, hot flushes…) they are also silent about being subjected to discomfort. “It’s got to be done hasn’t it?” they say. Has it? You think a man would suffer a squashed penis if there were other options out there?
No-one doubts that screening saves lives; however, many research studies reveal a lack of consensus on whether, overall, it does more harm than good. A few women will have their lives prolonged, many will undergo unnecessary surgery and treatment, all will be subjected to cancer-inducing radiation. I’m not advocating the end of mammography. But if the Hubble Space Telescope’s technology can lead to the latest digital version of mammogram data analysis, could we not look to the Large Hadron Collider, Apple, Lego (maybe not Lego - ouch) for new hardware? Diving down into our collective décolletage requires a cheap, safe, proficient gizmo, engineered to fit the female physique; not the other way around.