A Mammography Handicap
Breast Cancer Awareness Month reminds women the importance of an annual mammogram, but for women in wheelchairs, it’s not always an easy screening.
No one likes getting a mammogram, but ever since injuring her back in a car accident resulting in quadriplegia, Debbie Weaver dreaded the annual screening for breast cancer. Now that she uses a wheelchair, Weaver and the technicians at a women’s center in Chandler, Ariz., had a hard time getting her close enough to the machine while keeping her head out of the way of the camera, a problem other patients in wheelchairs have experienced as well.
“When I was initially in the chair, we couldn’t get the chair close enough to the machine. They did get it low enough, but again, it was getting my head out of the way and getting all of my breast,” Weaver says. “I don’t even know what percentage to throw out, but I knew that they weren’t getting as much of the breast as they were supposed to get.”
This problem continued for four years, something 60-year-old Weaver never dealt with before using a wheelchair, which is why she knew they weren’t seeing as much of her breast as they needed to.
Managing other secondary conditions that come with using a wheelchair, such as pressure sores and urinary tract infections, can overshadow this kind of easy maintenance. But mammography is just as important and shouldn’t be ignored.
“Mammograms are important for everybody. We want to catch things before they’re so big that you can actually feel them. You know that’s the thing, we’ve had people with even a dime-sized cancer, but they’re so deep that you would never feel them,” says Becki Hauser, Clinical Supervisor at John C. Lincoln’s Breast Health and Research Center in Phoenix. “ … We want to catch things early while they can be easily taken care of and not take a person’s life. That’s the whole purpose of mammograms.”
With such a critical screening, it’s important to find a method and health care center that can give you the breast cancer exam you need. Luckily there are several options for patients in wheelchairs.
An annual breast cancer screening is recommended for all women starting no later than age 40.
After struggling to obtain a good image from a mammogram for four years, one of the technicians at the clinic Weaver visits had a new idea: screening for breast cancer via ultrasound rather than mammography.
Now, every year when Weaver is due for a mammogram she has her primary care physician write a script to receive an ultrasound because of quadriplegia.
“It is great. No more trying to get close enough to the machine with my face being smashed, ‘cause that’s what was happening … [this is] much more comfortable,” Weaver says.
Oftentimes when a doctor finds a lump via mammogram, he or she will order an ultrasound to get a better look and understanding of what the lump is. Weaver believes she is just skipping a step in the process, but still getting a comfortable and thorough screening. Hauser, however, says this should be used as a last resort, not a primary option.
“That’s better than nothing, but the thing with ultrasound is it doesn’t pick up things like fine microcalcifications,” Hauser says. “It can see a lot of things in the breast, but that would be the main thing it would miss are those microcalcifications, and that’s way better seen on mammography.”
Before resulting to ultrasound exclusively, start with calling your primary care center and seeing what options it has for accessible mammography.
In accordance with the Americans with Disabilities Act, all centers should have a machine that adjusts to wheelchair height and has room for a wheelchair to be pushed up and under the machine (ada.gov/medcare_mobility_ta/medcare_ta.htm).
But even with these regulations, patients with spinal-cord injury or disease can still have trouble leaning in close enough and/or keeping their chin, head, shoulders and/or arms out of the way.
Hauser suggests finding a center where at least two techs are available to help, or bring a family member to help lean you forward while also holding your limbs out of the way of the camera.
“If it’s a positioning type of thing we would have another tech come in and help the patient, you know, maintain the position … just to keep the a chin out of the way, keep the shoulder out of the way, to just hold an arm up where they can’t maybe do that themselves … We can put pillows behind their back to try to get them a little closer, it just depends on what’s going on with the patient. We’ve seen just about everything,” Hauser says.
The wheelchair you come in can also be of big assistance. Weaver mentioned women who use wheelchairs that can rise to a standing position may have a smoother experience, similar to the standing mammograms able-bodied patients receive. Hauser also suggests coming in a wheelchair with arms that fold away or can be easily removed, if available.
If this is still too difficult or not a viable option, many centers, depending on your level of injury, can transfer you to a biopsy chair designed to easily pull up to the mammography machine. MD Anderson Cancer Center in Houston frequently utilizes this option.
“MD Anderson uses Hologic Selenia units and we perform mammograms on wheelchair patients,” says Julie Penn, Associate Director of External Communications. “If we have a patient that comes in a chair where we can’t remove the side arms to position the patient properly, we use a Hausted biopsy chair that we move the patient onto for better adjustability and positioning.”
This Breast Cancer Awareness month, take control of your breast cancer screenings.
Call your primary care center to find out how it can accommodate your mammogram, whether that’s through providing extra technicians to lend a hand, a biopsy chair or armless wheelchair to transfer to, or directing you to a center that would better suit your needs.
Hauser recommends annual breast cancer screenings beginning no later than age 40 — if you have a first-degree relative such as a mom or sister who’s had breast cancer, screening should start 10 years before the age at which she was diagnosed — and continuing annually for life.
“A lot of people say, ‘How long should I keep doing it?’ And I say, ‘How long do you plan on living?’” Hauser says.
A Mammography Handicap
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