The Alarming Thing I Didn't Know About My Mammogram

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"On the day my cancer was so large that it could be felt, it was undetectable on a mammogram."

(JoAnn Pushkin, on Mammograms and Dense Breast Tissue with Dr. Andrew Warheit)

I want to stop you right now from thinking, "Oh, this is just one of those older-lady things I'll have to deal with." Wrong. Dense breasts tend to be more common in younger women and in women with smaller breasts, but anyone — regardless of age or breast size — can have dense breasts. Here is my experience.

As I was leaving the exam room after my mammogram recently, the technician, whom I have now been seeing for nine years, asked, "Can I give you a hug?" It caught me off-guard, but I didn't think much of it and hugged her. It was only after I was getting into my car that I thought about what an odd thing that was to say.

And then I wondered: Had she seen something that made her want to hug me?

Two days later, my phone rang. It was the radiology office. "I need to schedule you for a mammogram," the receptionist explained. "I was just there last Friday," I said, thinking there was a mix-up. "No, um, we need to do another mammogram, and an ultrasound." I drew a breath, my heart pounding.

The receptionist went on to explain that there was an "area of concern" on my right breast, and that because I have very "dense breasts," the radiologist had recommended additional tests. "Dense breasts?" I was completely unfamiliar with this term. She attempted to explain that this meant it was difficult to see exactly what was on the mammogram, but something was suspicious.

Why Should You be Concerned About Dense Breasts?

According to the Susan G. Komen Foundation, "Women with high breast density are four to five times more likely to get breast cancer than women with low breast density." Add to that: The number of women who have breast density? 40% to 50%.

Yikes.

Like me, you may have been going merrily through your annual mammograms, thinking well, that's done, and I'll check it off for another year. What you may not know is that maybe nothing is being found… because it has not been seen.

What Does It Mean to Have "Dense Breasts?"

Here was the best description that I found: "It's like finding a polar bear in a snowstorm." Here are pictures of what you can see via a mammogram. As you can tell, it gets extremely difficult to see what's what.

Breast density is a measure used to describe the proportion of the different tissues that make up a woman's breasts. Breasts are made up of fat and breast tissue (the milk ducts and lobules, which may be called glandular tissue). Connective tissue helps hold everything place. Breast density is not a measure of how the breasts feel, but rather how the breasts look on a mammogram. It compares the area of breast and connective tissue seen on a mammogram to the area of fat. Breast and connective tissue are denser than fat and this difference shows up on a mammogram.

Put another way, "Breast density actually refers to how well a mammogram can 'see' any potential cancers or precancerous conditions within your breasts."

How Do You Find Out if You Have Dense Breasts?

Ironically, by having a mammogram. That is your starting place.

Having been down this road, I would even ask the technician, during your mammogram, if you have dense breasts. My second technician was very open to my questions during both the mammogram and ultrasound, and let me see the screens. I imagine, though, that may not be office policy everywhere.

Once you have had a mammogram, what should you do?

"Your next step," advises a breast health advocacy group Are You Dense, "is to request a copy of your mammography report from your referring doctor. Make sure it is the report that is generated from the radiologist and not a form letter. Read the report carefully. Look for descriptions of your breast tissue."

If your results are not clear to you from the report, contact your physician and ask for a further explanation.

Unfortunately, you cannot assume that you will be informed if you do have dense breast tissue, as not all states have passed legislation requiring notification. (Check your state.)

What if I DO Have Dense Breasts?

Hopefully, by reading this post, you will be armed with information (I wasn't educated about density, which lead me to feel very anxious and upset). What to do:

• Obtain a copy of your mammogram report. (I thought this breast density report, designed for clinicians, was helpful in understanding degrees of density and clinical recommendations.)
   
• Speak with your physician, paying special attention to your family history and lifestyle.
   
• Be ready for further testing, including ultrasound and/or MRI, if indicated. In my case, because there was a suspicious area, I had a second mammogram and an ultrasound. Fortunately, my insurance company paid for both tests.
   
• Don't panic, but do be proactive.

My radiologist's letter stated:

"Remember that if a woman has an area of the breast that needs further work-up, the vast majority of the time, the findings will not be cancer. Even when a biopsy is needed, the majority of the time, the diagnosis is not cancer."

Although my finding was "likely benign," my tests will be repeated in six months, which is fine by me.

What Causes Dense Breasts?

Somewhat disturbingly, things get vague, here. Some attribute it to rising estrogen levels, genetics, or postmenopausal hormone therapy, although there isn't much agreement.

Learning More

Read the very compelling story of Nancy Cappello, Ph.D, a Stage 3c breast cancer survivor. She received her diagnosis only two months after her annual mammogram came back as "normal." Her website, Are You Dense?, contains many eye-opening testimonials from women who have dense breasts.

There is a fine line between being an alarmist and educating someone when it comes to healthcare. My hope, honestly, is that I frightened you enough to make you be proactive.

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