Are you dense?

A hefty thanks to my good friend AnneMarie over at Chemobrain for alerting me to this topic. She wrote this post about a newly minted law in New York. I’m purposefully ill-informed about such current events; I don’t watch the news and I cherry-pick which stories I follow because the local news is full of big-city sensationalism and the national news wears me out, particularly with the uptick in political/biparty bickering. When election time rolls around, I do some concentrated research on my local and national candidates, but don’t need all the buzzy asides about which congressperson is misbehaving or which serial killer is still at large or who eye-rolled whom. As my wise friend Amy Hoover says, I know about all the current events in my home, and that’s enough to keep up with.

The news of the new dense breast laws did catch my attention, though, thanks to AnneMarie. And it got me thinking. It’s estimated that half of women over age 50 have dense breasts, and one-third of women younger than 50 have ’em. I was one of those under-50s with dense tissue, and these new laws make me wonder how things would have played out for me several years ago had such red-flag measures been in effect.

Breasts are a mix of fatty tissue and dense tissue, and dense breasts make it harder for a radiologist to spot a tumor on a mammogram. Because mammograms use x-ray technology, both tumors and dense tissue appear as white. Is it a tumor? Is it just dense tissue? It’s hard to tell, and if a potential tumor is dismissed as dense tissue, that’s a bad scenario. A study done by Dr Thomas Kolb, a radiologist in New York whose specialty is spotting breast cancer, showed that mammograms missed 60 percent of cancers in women with dense breasts. In addition, women with dense tissue are said to be five times more at risk for getting breast cancer, and dense tissue is a greater risk factor than a family history of the disease. Talk about a double whammy.

Several states besides New York — including California, Connecticut, Virginia, and the great state of Texas — have laws that require mammography providers to inform a woman if she has dense breasts. In Texas, the law is nicknamed Henda’s Law after a Dallas woman, Henda Salmeron, who was diagnosed with stage 2 breast cancer after her 2009 mammogram failed to find the tumor. Salmeron says she’d never even heard of dense breast tissue — on her body or anyone else’s — until she sat in an oncologist’s office hearing the details of her cancer.  While I’m not a fan of big government, considering that estimates say that 95 percent of women are unaware of their breast density, I’m liking the notification laws. Insurance companies will likely cry foul, citing increased costs and the potential of scaring women with such notification. The fact is, breast cancer — any cancer — is scary, and life is hazardous. But isn’t it better to know what you’re dealing with — in this case, dense breasts that may not be properly examined by a mammogram alone? The wording required by the New York version of the notification law is this:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician.”

In Texas, the wording is this:

“If your mammogram demonstrates that you have dense breast tissue, which could hide abnormalities,
and you have other risk factors for breast cancer that have been identified, you might benefit from
supplemental screening tests that may be suggested by your ordering physician. Dense breast tissue, in
and of itself, is a relatively common condition. Therefore, this information is not provided to cause undue
concern, but rather to raise your awareness and to promote discussion with your physician regarding the
presence of other risk factors, in addition to dense breast tissue. A report of your mammography results
will be sent to you and your physician.  You should contact your physician if you have any questions or
concerns regarding this report.”

Is this scary? Would opening an envelope to read this send you into a panic? I honestly don’t think so, but I’m on the other side of the island here, having already received the scariest news of “You have breast cancer.” Regardless of the fear factor here, as New York Govern0r Mario Cuomo points out, “Missed cancers, growing undetected until at a later stage, are less treatable, the least survivable and most expensive to treat.”

These notification laws can be traced back to a woman named Nancy Capello. A Wall Street Journal article describes Cappello’s story, which is rather similar to my own. A decade of mammograms for Capello showed dense breast tissue, but she had no idea that such tissue means a less-reliable mammogram.  When her latest annual mammogram showed a suspicious spot, she got an ultrasound to go along with her mammogram. The ultrasound showed a 2.5 cm tumor–the size of a quarter–which a decade of mammograms had missed. In the chain of events that follows a bad report from a radiologist after a mammogram, Cappello found that her stage 3 cancer has spread to 13 lymph nodes.

Capello asked her OB-GYN why women are not informed of their dense tissue and its potential to hide tumors and was told that it’s not standard procedure. While still in the thick of chemo and radiation, Capello set out to change the standard procedure. She founded  to educate women and require that they be notified of their risk. Capello went on a hunt for evidence-based science–not pink ribbon party lines– and found multiple studies involving more than 42,000 women (ironically, slightly fewer than the number of women who die from breast cancer in the United States each year). These studies show that for women with dense tissue, adding an ultrasound to a mammogram nearly doubles the rate of tumor detection — from 48 percent to 97 percent.

Like Capello, I dutifully got my mammogram every year, even thought I was a long way from 50 when I got my first one.  My annual mammograms started at age 36 because my mom died of ovarian cancer and my OB-GYN (who is married to an oncologist at MD Anderson) is very pro-active. Every year my mammo came back questionable, and the reason cited was dense tissue. However, the citing was never presented in a manner that raised a red flag, and since I was “so young,” that dense tissue didn’t seem like any big deal. One year my OB-GYN sent me to a breast specialist, just to be on the safe side, and I had a biopsy but it came back negative. Fast-forward a few years to DCIS and invasive tumors in one breast, and Paget Disease and 5 cm of cells just waiting to become a tumor in the other. While I knew I had dense breast tissue, I had no reason to think it was anything more than just a particular feature of my body, like the chicken-pox scar on my forehead, or my small feet, or the birthmark on my shoulder. I thought I was doing my due diligence by getting a mammogram every year, despite my young age. The knowledge that we learn after the fact is the most hard-won because it often turns out the be the turning point. How was I supposed to know that my dense breasts were concealing a growing cancer, and that an ultrasound or MRI could have found it years before it had a chance to become a force that would turn my life upside-down? Lessons learned the hard way.

While the notification laws weren’t on the books during my mammogram days, they are now, and hopefully some women who receive these notices will go on to get ultrasounds and/or MRIs to rule out or confirm breast cancer. In an ideal world, every woman would be well-informed and proactive about her health — including her breasts — and would have access to the information, the screening, the guidance, and the care needed to navigate this situation. In an ideal world, we wouldn’t need the government to tell us that our mammogram showed dense tissue and that may be a red flag. In an ideal world, women like Henda Salmeron and Nancy Capello would never be shocked by the knowledge obtained after it’s too late to stop the speeding train that is a cancer diagnosis. In an ideal world, a woman who received a state-mandated letter about her dense breasts and the potential for more serious problems in them wouldn’t have to worry about how to pay for that ultrasound or MRI. But we all know we don’t live in an ideal world.

One thing is certain: I don’t need to worry about my dense breasts anymore, since they’re gone.


14 Comments on “Are you dense?”

  1. I’m dense, too….. Or I was… like you….. Thanks for expanding on everything I wrote and for the shout out, too… And thanks for the comment on my blog! I’m ready to reprint the article that appeared in the local newspaper. It claimed this law may save the lives of 2500 New Yorkers this year. The problem, about 2700 will die of breast cancer this year….. Are we ready to claim that EVERY DAMN DEATH could be avoided??? That’s the stupidity that gets me pissed off…. kinda goes with the theme of today’s rant. One of my all time fav’s. Let’s Skew The Stats.


  2. Jody Hicks says:

    Good timing for me – I’ll be getting a routine check-up tomorrow which will include scheduling my annual mammogram, and I’ll remember to ask about this. Thanks so much!

  3. I’m dense too…literally and figuratively. I have Cowden’s Syndrome which makes me super high risk for breast cancer…and I just had my 2nd breast MRI. I have to admit that all this talk has me very confused and having a rare disease makes it even worse – (For me) since there’s such limited info out there RE breast cancer and Cowden’s. I’m glad to have found your blog via beatingcowdens.

  4. mmr says:

    Thanks– am going to forward to my sister in CO. She has the dense breast problem, had reduction about the time of my surgery, but that didn’t seem to help; she keeps getting the callbacks.

  5. It’s very interesting to read all of this. I have one breast remaining, and I wonder if it is or isn’t dense. (It’s certainly small.) As far as I can tell, it’s not standard practise to tell the patient about their breast density here in Ontario (not sure about the whole of Canada), but I sure would prefer if they did! ~Catherine

  6. You certainly have a way with words….informative and entertaining. I am going to adopt this saying:” I know about all the current events in my home, and that’s enough to keep up with.”

    • Amy H. says:

      Wow, CW! I was surprised that Nancy took that little nugget of my own fingers in ears “la la la” mentality regarding local and national news to heart! I rely on my husband to keep me informed of most of the local, state and national news. He relies on me to keep him up to date of “the events in our own home” although as a caveat I must say he is definitely engaged in those home events. It’s a good system and I’m a bit saner because of it. Thus today I fought school district bureaucracy in my world. Who knows what else happened in the larger world…..Bueller? Bueller?

  7. First ever mammogram: Sept, 2010, negative, as in no cancer, nothing to worry about. Age 38. Oct, 2010 about one MONTH later, diagnoses: Stage 3, HER2+ cancer. When I asked how on earth this could happen, I was told “you just have dense breast tissue”. Excuse me? “JUST”. Yes, this is a huge issue that needs attention.

  8. Reblogged this on anotheronewiththecancer and commented:
    This is a huge issue, and it is scary it is not at the forefront of discussions with every woman. Women with breast cancer–regardless of their density–should know about this, yet, not all do. Why?

  9. bcrcrider says:

    Reblogged this on Riding the BC Roller Coaster and commented:
    Yep, I’m dense too. When I was diagnosed, I was told that my cancer was slow-growing (yay!) and had probably been there for many years. I’ve had a mammogram prolly 3 years ago or so – it came out all clear, BUT in hindsight, I’m guessing the cancer was there, but missed. Wonder how things would’ve been different if it’d been caught before it was big enough for me to feel. Well, lesson learned – from now on I’m fighting for ultrasound/MRI with my mammogram, thank you very much!

  10. Amy H. says:

    You impress me with the depth of your research. I had no idea. Thanks for the heads up!

  11. christy says:

    I got one of those notifications last year, remember? I was happy to take 3 more hours of squeezing, poking, and prodding only to find that my breast is, indeed, only dense. I like this law!!!

  12. Many thanks from us to your good friend AnneMarie in New York. Over at Chemobrain for alerting you to this topic about a newly minted law.

  13. I am 53 and a aneurosym survivor 1 ruptured and one clamped.This was 2 yrs ago since my surgery.I had fibersistic tumors at a young age.One surgery to remove the tumorI was in my late 20’s then at 53 I just recieved my mammogram saying I have dense breast.I to have never heard of this just like my aneuroysm never have I heard of.So many hidden things in our body that we do not even exist..I now have my report.I am a fairly calm person under health issues.After my brain surgery.i can now say I take life more serious.Soo I have read many articals now from different places on what dense breast means.Today I know many cancer survivors.Does this mean I will be one to have to choose to take that risk of keeping my breasts and or just taking the chance all is okay.2 yrs ago on my mammogram it said nothing.I am always so tired and stay mixed up from my brain surgery.This again puts the fear of myself not only having to face something again so serioius.My body is tired 6 yrs ago a ruptuered brain anerorysm then 2yrs ago another but it was caught and clamped.Then over the summer 3 kidney surgeries. For my kidneys called another disease.THEYhad to completely rebuild the tube in the bladder and kidney because it kept collapsing .Again I am so tired.I will always fight for my life.I just hate not knowing what I face next.Thanks for being able to read on this.Spreading the word on so many health problems needs to get people aware.I would rather loose both breasts than take the chance.Igo see my Dr. Next week to discuss these results.Good luckto all of u.And thanks for sharing ur stories with the world God bless u all.

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