Dense Breast Tissue a Risk Factor

As reported in today's New England Journal of Medicine, a recent study found that dense breast tissue is a risk factor for breast cancer. This confirms what I suspected about my own breast cancer.

I have always had dense breast tissue, and every doctor who examined my breasts throughout the years commented on that fact. When a routine mammogram was done on me at 47, about one year before my cancer diagnosis (and I admit it was the first mammogram I'd had in more than a decade), again I heard that I have dense breasts. Having gotten the 'all clear' sign from both my doctor and the radiologist who read my mammogram helped me put the possibility of breast cancer out of my mind.

After all, I figured, since I'd nursed my last child for a full year and there was no history of breast cancer in my family, not to mention that I was still in my 40s, breast cancer was the last thing I could reasonably worry about. And while I was loathe to do breast exams, my husband was happy to do them for me, after a fashion.

Then there was that day in October of '05 that I found the lump in my breast. It felt to be about as big as a macadamia nut. I'd like to say that this lump was discovered during a search or an intimate moment, but truthfully it was when I was talking at the dinner table and gesticulating, as usual. I put my hand to my chest for effect, and my fingers noticed something amiss.

Panic ensued. Every breast cancer survivor remembers this panic. Words cannot begin to describe it, but I've learned that for mothers it's especially excruciating.

Thank God I'm in a huge HMO (Kaiser Permanente) and my ob-gyn was able to see me right away. He examined my breasts and also felt the lump. Hoping to find fluid which might indicate a benign cyst, he inserted a needle into the mass and drew back on it. I think everything in the world stopped for a moment while I waited to see what substance would fill that syringe. The syringe stayed empty.

Now this doctor had been touching my breasts for 10 years or so. He was the one who sent me for my first and unremarkable mammogram the year before. Nothing was mentioned at any point that my mass might have remained unnoticeable on a mammogram, but my doctor did mention that the size of the mass, if cancerous, indicated it had been growing for a while, maybe years.

Off I went to the mammogram place, and mine showed no mass at all. The technician probably thought she was doing me a favor when she mentioned that the nipple on that same breast was inverted, a 'very bad sign,' said she. I think I was hyperventilating at this point.

At the request of my doctor, I proceeded to the ultrasound room where the mass was finally seen. I was furious, especially after the pathology report came back and I found out the mass was malignant.

How in the world could it be possible, in this day and age, that any sizable mass could be unseen by mammogram, and all over the country and the world women rely on mammograms to determine if they need to be tested for breast cancer!!

Isn't it awfully likely that the mass in my breast was already big enough to be seen on an ultrasound when I had that 'clear' mammogram a year before? If anyone had an inkling that dense breast tissue will hide a mass, they sure didn't mention it to me or any of my doctors.

It seems to me that the study results were so very clear that preliminary results should have been reported to the medical community and the public, allowing women who know they have dense breast tissue to push for routine ultrasounds instead of or in addition to mammograms.

Yes, the likelihood of insurance companies allowing a more expensive test on women who have no other risk factors is nil. Now those same insurance companies need to be directly ordered to pay for such tests if a woman's doctor agrees that the test is a necessary screening tool.

Perhaps breast cancer will kill me. I know now that my odds of living 10 years are not great. If I'd had an ultrasound a year before diagnosis, perhaps my odds would be better.