There’s something you need to know about a very important health concept that can actually change the accuracy of your mammograms. If you haven’t heard this news, don’t skip this article. What you’re about to read could very well save your life.
Cheri had been having annual mammograms since the age of 42. In her mid-fifties, Cheri discovered a lump on her breast. Luckily, she already had a routine mammogram scheduled. Cheri was relieved when the results of the mammogram were NORMAL.
Eight months after the mammogram, Cheri noticed that the lump was not only growing, it was now visible. She thought that it was probably a blocked duct, but decided to have it checked out anyway. Consequently, her gynecologist ordered an ultrasound and a biopsy.
Are you ready for the kicker?
Cheri’s biopsy confirmed that she had developed invasive breast cancer which had metastasized to the lungs, lymph nodes, and bones. That’s right -- Cheri’s cancer had gone completely undetected despite having a routine mammogram.
The radiologist then showed her the previous mammogram and delivered a shocking statement. “You have very dense breasts,” the doctor stated. Here’s the thing: no one had ever told her this despite decades of mammograms.
On January 10, 2016, cancer won the battle. Cheri tragically died from an issue that many women aren’t even aware of: the inaccuracy of mammograms when it comes to dense breasts.
The information that you just read was adapted from a blog post that Cheri bravely wrote in an effort to teach women about the dangers of dense breasts. Cheri’s goal was simple: to advocate the need for women to be informed if and when they have dense breasts.
Unfortunately, Cheri’s story of having a false normal reading on a mammogram due to dense breasts is not unique. Scores of women have had the same experience.
You see, medical professionals estimate that 40 percent of women have dense breasts, though many women don’t know it. And how dense the breast is interferes with the accuracy of a mammogram. This is why Cheri’s mammograms came up normal, when in fact she had cancer.
Further, Cheri could have been informed of her elevated risk of breast cancer. Dense breasts are a PREDICTOR of cancer, but no one told her that either.
Even more concerning, it’s not tough to tell if a breast is dense on a mammogram. Healthcare professionals can determine if breasts are dense by reviewing the results. In dense breasts, the tissue appears white. That’s because they’re less fatty but more fibrous.
The question is: why are mammograms incorrect when it comes to dense breasts?
Dense breasts act as a mask of sorts. In general, cancer appears white on a mammogram, just like dense breasts. As a result, it’s tough to actually see cancer. This is why mammograms are thought to miss cancer in EVERY OTHER CASE when dense breasts are involved.
This brings us to another important question. Is there a difference in dense breasts, or are all dense breasts considered the same?
If your breasts are determined to be dense, a general level of breast density is assigned by healthcare professionals. This is done through a system called BI-RADS.
According to the Mayo Clinic, this system consists of four levels of breast density. The first is classified as “almost entirely fatty.” This occurs in just one out of 10 women. In this classification, the breasts are nearly all fat.
The second category is called “scattered areas of fibroglandular density.” This means that while some of the breast is dense, most of it is not. It is thought that four out of 10 women fall into this category.
The third classification category is titled “heterogeneously dense,” which means that most (but not all) of the breast is dense. This also affects about four in 10 women.
And finally, breasts can be labeled as “extremely dense.” This means that almost all of the breast tissue is dense. This affects roughly one in 10 women.
The last two categories are considered to be truly dense breasts. And according to the Mayo Clinic, about fifty percent of women who have mammograms fall into these two categories. Yes, that's right, half of all women who actually have mammograms are found to have dense breasts.
If medical professionals determine that a patient does have dense breasts, experts say that other screening steps may be necessary to detect breast cancer. There are several options in this respect.
The first option is digital mammography. According to Dr. Kathy Schillling, “digital mammography performs better in dense breasts than analog mammography.” Further, the patient can request a type of mammography called tomosynthesis. This is 3D mammography. Schilling says that this type of mammography elevates the chance of detecting invasive cancers more than traditional mammography.
Ultrasound and Magnetic Resonance Imaging (MRI) are also options. In fact, Schilling says that MRI is the go-to method for women who have a very high cancer risk. Molecular Breast Imaging (MBI) or Breast Specific Gamma Imaging (BSGI) can also be used. This method involves the use of a radioactive contrast agent that generates fewer false positives in dense breasts.
Further, Schilling says that contrast-enhanced spectral mammography (CESM) can be used if a general mammogram comes back with an inconclusive or abnormal result. This method relies on iodine to show contrast in terms of increased blood flow. This may signal cancer in general.
If an individual does discover that she has dense breasts and is aware of the risks and alternate screening procedures associated with this condition, she is lucky. In truth, Cheri’s story is not rare. Many women have had similar experiences.
One of those women is Dr. Nancy Cappello. A proactive individual, Cappello made it a point to take preventative healthcare steps in the way of breast cancer. She ate healthy, conducted monthly self-breast exams, exercised every day, and got an annual mammogram. She didn’t worry excessively as she was considered low-risk in that no close relatives had ever been diagnosed with the disease.
She, like Cheri, was clueless when it came to the fact that she had dense breasts. In 2003, Cappello received a normal result on her yearly mammogram. However, in a routine wellness visit, her doctor found something concerning. That concern was a ridge in her right breast. Consequently, she was sent for a second mammogram as well as an ultrasound.
This very act saved her life. Though the second mammogram was normal, the ultrasound picked up a 2.5-centimeter lesion. Further tests confirmed a shocking diagnosis. Cappello had stage three breast cancer -- and it had spread to 13 lymph nodes.
Cappello felt duped. In fact, she didn’t even know what dense breast tissue was. When she asked why she wasn’t told of her breast density and the risks associated with it, she received a terrifying reply: it wasn’t protocol.
Her life changed in an instant. To treat the cancer, she was given a mastectomy in one breast as well as multiple chemotherapy and radiation treatments. The struggle wasn’t one she ever expected to face.
But she wasn’t about to let other women suffer the same fate. She became an advocate of dense breast awareness. And to give voice to her cause, she founded both Areyoudense.org and Areyoudenseadvocacy.org.
“In the unlikely event that you have cancer, you want it found as early as possible,” says Cappello. “So if you have a tool that is limited, first of all, shouldn’t women know that? They should also have access to adjunct screening.”
Cappello says that teaching women this message starts with legislation that requires doctors to tell patients if they have dense breasts. However, health care providers should be discussing the impact of dense breast tissue on the reliability of the mammogram regardless of the status of density reporting legislation.
Currently, only 24 states officially require doctors to readily tell women this information, although eight other states are introducing legislation in 2016. Cappello wants this act to be required of every single state across the board. A federal bill to standardize the communication of dense breast tissue across the country has been introduced in both the Senate and House.
Further, the advocate wants procedures associated with adjunct screening for dense breasts to be covered under all insurance plans. “We know that a barrier to any procedure is having the availability to pay for it,” says Cappello. “In order for screening to be accessible to every woman, it must be covered or assigned a minimal copayment. Under the affordable care act, mammography is covered. An adjunct test may be covered by insurance but only after the deductible is reached. ”