Should I worry about dense breast tissue?

You have dense breasts. Now what?

The Federal Drug Administration (FDA) has proposed a change that requires mammography facilities to include information about breast density in letters to patients regarding their annual mammogram. Although this is a change on a national level, Minnesota has been required to share this information with patients since 2014.

The intention is to make women aware of whether they have dense breast tissue so they can decide, in consultation with their health care provider, whether or not to pursue additional screening breast imaging. This is a very personal decision. Being told you have dense breast tissue should not cause undue anxiety. Dense breast tissue is a normal finding, and about half of all women have dense breast tissue.

If you have dense breast tissue, this means you have a higher proportion of glandular breast tissue to fatty tissue. Having dense breast tissue can make it more difficult to see breast cancer on a mammogram. Dense tissue appears white on a mammogram while fatty tissue appears black. Breast cancer on a mammogram appears as a white spot, which is why it can be more difficult to see when the background is white as it is with dense tissue.

Breast density also slightly increases your risk for breast cancer. But dense breast tissue alone is not a major cancer risk factor.

If you have been told you have dense breast tissue and are concerned, talk with your doctor. Depending on your risk factors and personal preference, together you can decide if additional screening tests are right for you. If you are at average risk, you could consider doing 3D mammography for your annual exam. This screening tool has been shown to increase the detection of invasive cancers.

Six things you should know about breast cancer risk

There’s no one big way to reduce your risk for breast cancer, but a combination of approaches could make a difference.

Updated: October 26, 2016Published: January, 2007

In recent years the statistical picture of breast cancer has brightened, thanks to early detection and advances in treatment. More tumors are being caught at an early stage; the rise in incidence of the disease has slowed; and the death rate has dropped. Nevertheless, breast cancer is still the most commonly diagnosed cancer in women and the second most likely (after lung cancer) to take their lives.

Data aside, breast cancer looms large in our health concerns because most of us know it personally. Some of us have had the disease ourselves, and others have experienced it through friends or relatives. Particularly unsettling is its seeming randomness: Nothing seems to explain why one woman develops breast cancer and another doesn’t. Granted, family history and certain gene mutations can substantially increase risk. But such factors aren’t involved in most breast cancers. Moreover, we can’t do much about them, or about many of the other risks associated with the disease, including older age (the 10-year risk of developing breast cancer jumps from 1 in 48 at age 40 to 1 in 26 at age 60), early menarche (first menstrual period), having no children (or bearing the first at a later age), and late menopause.

Researchers have found associations between certain nutritional factors and breast cancer risk, although not all associations have resulted in risk-reducing strategies. For example, the American Institute for Cancer Research has found there just isn’t enough evidence to recommend for or against many of the things that once seemed promising, such as eating more soy or taking supplements like vitamin E, vitamin C, or selenium. Researchers have found little support for the common assumption that dietary fat increases breast cancer risk, and the evidence that fruits and vegetables are protective is weaker than was once thought.

But evidence is accumulating that we can lower our risk through certain healthy lifestyle choices, such as increased exercise, and clinical studies suggest some medical strategies. Medicine had much less to offer as recently as 1996, when the best we could say was, “Unfortunately, there is little we can do to reduce our risk of breast cancer.” New information is developing all the time, but for now, here are seven factors that could affect your risk and what you can do about them:

1. Weight gain

Many studies show that weight gain is a risk factor for breast cancer after menopause. An American Cancer Society study found that women who gained 20–30 pounds during adulthood (that is, after age 18) were 40% more likely to develop breast cancer after menopause than women who gained no more than 5 pounds. The link is estrogen, which is believed to promote the development of breast cancer. Fat tissue converts precursors in the body into estrogen, keeping the hormone in circulation even when ovarian production stops at menopause.

A Nurses’ Health Study (NHS) concluded that weight gain since age 18 or since menopause increases the risk of breast cancer in postmenopausal women, except those who are using postmenopausal hormone therapy. (In women taking hormones, the external source of hormones is much higher than what can be made by body fat, so the fat doesn’t contribute to increased risk.) The NHS researchers also found that losing 22 pounds or more after menopause decreased the risk of breast cancer.

What to do? Do all you can to avoid gaining weight as an adult, and try to enter menopause at a healthy weight. If you’re overweight, try to lose weight.

2. Activity level

Many studies have shown that women who engage in regular physical activity have a lower risk of developing breast cancer compared with women who are sedentary. You may reduce your risk by 20%–30% by getting three to four hours of weekly exercise, from moderately intense (brisk walking and yoga, for example) to vigorous (such as jogging, cross-country skiing, and aerobic dance). Exercise also reduces the risk of recurrence if you have been treated for breast cancer.

Regular exercise works in several ways. It can help you achieve and maintain a healthy body weight; it may influence circulating hormones and reduce the exposure of breast tissue to estrogen; and it can influence levels of insulin and insulin-like growth factors, which have been linked to the growth of breast cancer cells.

What to do? To reduce breast cancer risk, the American Cancer Society recommends moderate to vigorous activity for 45–60 minutes on at least five days of the week. (This is a step up from the 30 minutes of moderate activity most days of the week that’s recommended for reducing chronic disease risk in adulthood.) Formal exercise (such as walking programs, swimming laps, cardio-fitness workouts, or aerobics classes) is a good way to get a sustained workout. But you can also do housework or gardening activities — as long as you breathe as hard as you would during a brisk walk or jog.

Online breast cancer risk assessment tool

National Cancer Institute www.cancer.gov/bcrisktool

3. Alcohol

Women who consume even a few drinks per week have an increased risk for breast cancer. It’s not known exactly why. Alcohol may raise estrogen levels, an important player in the development of breast cancer. It may interact with carcinogens or inhibit the body’s capacity to detoxify them.

What to do? Women at average risk for breast cancer should limit their intake of alcohol to one drink per day. Women who have had breast cancer or are at increased risk for it for other reasons may want to avoid alcohol altogether.

4. Vitamin D

Higher blood levels of vitamin D are associated with a lower risk of breast cancer compared to women with low levels of the vitamin. For example, one study found that women who got plenty of vitamin D in early life — either in their diet or by spending time outdoors, where sun exposure triggers vitamin D production in the skin — had a lower risk for breast cancer. Another investigation linked high blood levels of vitamin D with a 50% reduction in risk for breast cancer. Reaching those levels requires more than the recommended intake of 400 International Units (IU) of vitamin D per day for women ages 50–70.

What to do? Experts have already begun to recommend 800–1,000 IU of vitamin D per day for adults, partly out of concern that we aren’t getting enough of the vitamin from sunlight to protect our bones and partly because of its association with reduced cancer risk. Natural food sources of vitamin D are limited, and not everyone can get the amount of sunlight needed to trigger adequate vitamin D production in the skin. The best bet is supplemental vitamin D. A standard multivitamin usually supplies 400 IU; you can get an extra 400 IU in a vitamin D supplement.

5. Medication risks

Lifetime exposure to estrogen is a risk factor for breast cancer, so there is some concern about women’s use of oral contraceptives and postmenopausal hormone therapy.

The Nurses’ Health Study found that women taking birth control pills have a slightly increased risk of breast cancer, but it falls to average within 10 years of stopping. An analysis published in the Mayo Clinic Proceedings found that premenopausal women who use birth control pills have a slightly increased risk of developing breast cancer before age 50, especially if they started taking them before having their first child.

The Women’s Health Initiative trial showed that long-term use of combined hormone therapy (estrogen and progestin, as Prempro) slightly increases breast cancer risk, although the level of risk drops back to normal five years after stopping the hormones. Estrogen therapy alone does not seem to increase the risk.

Studies have shown that women who took the drug diethylstilbestrol (DES) during pregnancy (to reduce the chances of a miscarriage) have a higher risk of developing breast cancer. Research suggests that the daughters of women who took DES are also at increased risk.

What to do? Birth control pills and hormone therapy have risks as well as benefits. Discuss them with your clinician before deciding whether to take them or for how long. If you know your mother took DES when she was pregnant with you, or if you took DES yourself, let your clinician know so you can discuss a screening schedule.

6. Breast density

Breasts are regarded as dense if they have less fat and more connective and glandular tissue. These features are more common in younger women’s breasts, but they are also found in many older women, especially those taking combined hormone therapy (estrogen and progestin). Breast density is also partly a heritable trait.

For reasons that aren’t fully understood, women with dense breasts are at increased risk for breast cancer. In fact, breast density is trumped only by age and the BRCA1 and BRCA2 gene mutations in the hierarchy of risk factors. One possibility is that dense breast tissue contains more cells and is therefore more influenced by growth factors and hormones that make cells divide.

What to do? Unfortunately, breast tumors (both cancerous and noncancerous) can be difficult to distinguish against a background of dense breast tissue on a mammogram. That’s because tumors and dense tissue appear white; fatty tissue, on the other hand, looks darker and provides a contrast to the tumors. Digital mammography has been shown to improve cancer detection in women with dense breasts, because it allows the radiologist to fine-tune images so that tiny abnormalities stand out better. Ultrasound or MRI can also help answer questions raised by a suspicious mammogram. Much more needs to be learned about breast density before official recommendations can be made. In the meantime, if you have dense breasts, talk to your clinician about screening with digital mammography.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Annual mammograms are recommended for women age 40 and over to screen for breast cancer. Your radiologist may then notify you if you have “dense breast tissue” (as about half of women do). It’s nothing to worry about, but additional screening tests are recommended because mammograms are less accurate in detecting cancer in women who have dense breasts.

You can’t tell if your breasts are dense simply based on your body type, weight or the size and feel of your breasts. “Dense breast tissue is determined by the way the breast looks on the mammogram, not by how the breasts feel on physical examination,” says Regina Hooley, MD, a Yale Medicine radiologist, who is a breast imaging expert at the Breast Center at Yale Cancer Center and Smilow Cancer Hospital. Women with dense breasts should consider further tests, including ultrasound or magnetic resonance imaging (MRI), depending on breast cancer risk. At Yale Medicine, women who don’t have dense breasts are told this when their mammograms are read, so they don’t have to wonder.

Be sure to contact your insurance company before scheduling a mammogram or additional screenings to check your coverage.

The breast density-breast cancer connection

Published: October, 2011

Women whose breasts appear dense on mammograms have a higher risk for some aggressive breast cancers.

One of the strongest known risk factors for breast cancer is high breast density — that is, relatively little fat in the breast and more connective and glandular tissue, as seen on a mammogram. Now, a study has found that higher breast density in postmenopausal women increases the risk of specific types of breast cancer, including some that have a relatively poorer prognosis.

The bad news is that — like gender, race, family history, and genetic endowment — breast density is pretty much out of our control. The good news is that as we get older, our breasts tend to become fattier and less dense. Still, some women continue to have dense breast tissue well into their later years.

Breast density

The breast on the left is mostly fat, which appears gray on a mammogram; the breast on the right is mostly dense tissue, which appears white. Tumors and other abnormalities also appear white, so they can be difficult to spot in dense tissue. Mammographic breast density is often classified using a system called BiRads, where 1 is “almost entirely fat” and 4 is “extremely dense.”

Images courtesy of Rulla M. Tamimi, Sc.D., Harvard Medical School.

The study

Some risk factors, such as age, body mass index after menopause, and past use of postmenopausal hormones have been linked to distinct types of breast cancer. But the relationship between breast density and tumor type is less well understood. To investigate, researchers at Harvard Medical School and Brigham and Women’s Hospital in Boston compared breast density in 1,042 postmenopausal women who had breast cancer and 1,794 age-matched women who did not have breast cancer. All were participants in the Nurses’ Health Study, which has followed more than 120,000 women for 35 years.

As expected, the risk of breast cancer was higher for women with higher breast densities. Women with 50% or higher breast density on a mammogram were three times more likely to be diagnosed with breast cancer over a 15-year period than women with less than 10% breast density. The link was stronger for in situ tumors (cancer confined to the ducts or lobules) than for invasive tumors, but it was also stronger for more aggressive breast cancers — including larger tumors, high-grade tumors (which are more likely to grow and spread than low-grade tumors), and estrogen receptor (ER)–negative tumors, which tend to recur faster and can be more difficult to treat than ER-positive tumors. Until this study, research had suggested that breast density was equally associated with ER-negative and ER-positive tumors. The findings appeared online July 27, 2011, and in print Aug. 3, 2011, in the Journal of the National Cancer Institute.

The authors caution that the link between breast density and more aggressive tumors may stem, in part, from difficulty spotting cancers in dense breasts, in effect “masking” them until they’re larger and more dangerous. However, other studies have shown that the link between breast density and breast cancer risk, in general, is strong independent of this masking effect.

What now?

If you’re postmenopausal and have dense breasts, here are some things to think about:

  • Breast density is an important risk factor, but it’s not the only one (for a list of risk factors, go to www.health.harvard.edu/womenextra). You and your clinician should know your risk profile and plan screenings and office visits accordingly.

  • Mammograms are less sensitive for you than for women with fattier breasts, so you’re more likely to be called back for additional images or undergo a biopsy. Your radiologist may also want to obtain more images using a different method.

  • Hormone therapy increases breast density, so if you’re considering it for severe menopausal symptoms, you may want to explore other options.

  • If your overall risk for breast cancer is high, you may want to consider chemoprevention with tamoxifen, which can reduce breast density. A 2008 study showed that women whose breast density decreased by 10% or more within the first year or so on tamoxifen were 63% less likely to develop breast cancer than women taking a placebo.

  • Mammography has been the main focus of breast cancer detection, but almost half of breast cancers in women ages 50 to 69 are first found by the women themselves or their clinicians, according to a study in the August 2011 Journal of Women’s Health. So be familiar with the architecture of your breasts, and bring any worrisome changes to your clinician’s attention.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Breast Density – What You Need To Know

Breast density is in the news a lot these days – just what is all the fuss about? Let’s review the facts about breast density and your breast health: What is breast density?

  • Breast density is a description of the makeup of your breast tissue and its appearance on mammography.
  • Breasts contain fat (dark gray on a mammogram), varying amounts of glandular tissue (white) and supporting structures (linear white).
  • Breast density may vary based on hormonal changes.

Why does breast density matter?

  • The more glandular tissue, the harder your mammogram is to interpret!
  • Breast cancers often appear as white, star-shaped masses or may appear as tiny flecks of white.
  • It is much harder to find a small white mass or speck of white on a background of white tissue than it is on a background of dark gray.
  • Further, studies have shown that for those women with the densest breast tissue, there is a slight, probably around 4% increase in the risk of breast cancer.

How do I know what my breast density is?

  • Breast density is determined by your radiologist from your breast imaging.
  • You cannot determine breast density from a physical breast exam- either by you or your doctor!
  • Your breast density will be classified on your mammogram report as:
    • Fatty (10% of women)
    • Scattered fibroglandular tissue (40% of women) – meaning a mix with around 25-50% of the breast being glandular or white mammographically
    • Heterogeneously dense (40% of women) – meaning a mix with 50-75% of the breast glandular
    • Extremely dense (10% of women) – meaning over 75% glandular
  • Breasts with density in the last two categories are considered dense.
  • As breast density increases, the mammogram becomes progressively whiter.

Where do I find out my breast density?

  • Many states have passed laws requiring the reports we give to you include information on your breast density.
  • We have been providing information on breast density to our patients for the past few years along with the results we provide before you leave our office.
  • If your facility does not provide this information to you, your doctor’s mammography report should contain a statement on breast density.

What should I do now?

  • Knowledge is power. Breast density is just one factor which influences breast health.
  • If you have no other risk factors for breast cancer other than being female and being over the age of 40, screening with annual mammography and careful clinical breast exams every year will likely be all you need. 3D mammography would be beneficial. Be compulsive and come for that mammogram every 12 months!
  • If you are at higher risk for breast cancer due to family history of breast or ovarian cancer or from other factors like radiation to the chest, additional screening tests may be helpful.
  • Consulting with your doctor or with a genetic counselor can help determine your individual risk for breast cancer.
  • For those with a lifetime risk of over 20%, breast screening should consist of mammography and breast MRI every year, alternating each test every 6 months.
  • If your risk is less than 20% or if you are unable to tolerate MRI, screening with breast ultrasound in addition to mammography is an alternative.

No matter your breast density, remember this: mammography saves lives. Make sure you and all those you love get the screening they need.

Originally published 9/22/15 on mammographykc.com.

Low breast density in mammography worsens breast cancer prognosis

In the future, these findings may prove significant for the assessment of breast cancer prognosis and treatment planning.

The study involved 270 breast cancer patients at Kuopio University Hospital, aged between 32 and 86 years. Breast tissue density was analysed on the basis of mammographic images obtained at the time of diagnosis. The researchers determined the proportion of dense glandular tissue of the overall breast area. Breast tissue density was categorised as low when the proportion of glandular tissue was below 25%, and as very low when the proportion of glandular tissue was below 10%. The study was a six-year follow up focusing on the effects of breast tissue density and other mammographic features on breast cancer prognosis.

The results indicate that a very low breast tissue density is an independent poor prognostic factor of breast cancer, regardless of patients’ age, menopausal status or body mass index. Out of the women with very low breast tissue density, 70.7% were alive at the end of the six-year follow-up, whereas out of women whose proportion of glandular tissue was higher than 10%, 87.7% were alive at the same time. Lower breast tissue density was also associated with more aggressive higher grade tumours.

The results are particularly interesting because dense breast tissue has long been known to be associated with an increased risk of cancer. “It is difficult to detect small tumours when screening dense breasts, and this results in a higher occurrence of clinically detectable interval cancers. In the U.S., it is nowadays mandatory to let patients know if they have dense breast tissue. This allows them to choose whether they wish to have further tests, for example a screening ultrasound,” says Professor Ritva Vanninen.

“It could be assumed that dense breast tissue would also be associated with a poorer prognosis in patients with a recently diagnosed breast cancer. However, this was not the case in our study, as low breast tissue density specifically weakened the prognosis.”

“I was trying to focus in on who’s really at high risk of having their breast cancer not seen on mammography,” said Dr. Karla Kerlikowske, the first author of the study and a professor of medicine and epidemiology and biostatistics at the University of California, San Francisco. “It can’t be 45 percent of people.”

Dense breasts have a relatively high proportion of glandular or connective tissue, which shows up as white on mammograms. Tumors also appear white, so dense tissue can hide them. Non-dense breasts have more fat, which looks dark on mammograms, so tumors stand out more easily.

Density can be detected only by mammograms and is reported in one of four categories, from “almost entirely fatty” to “extremely dense.”

The study findings are based on the medical records of 365,426 women ages 40 to 74 who had screening mammograms from 2002 through 2011. The researchers wanted to know if they could detect whether, among all the women with dense breasts, any distinct subgroups had a higher risk than others of developing an “interval” cancer, meaning one that is found less than a year after a normal mammogram.

Such tumors, usually found when a patient or her doctors feel a lump, may have been present but not detected by the mammogram.

The report uses breast density assessments along with an online calculator that estimates a woman’s risk of developing breast cancer in the next five years. The calculator asks five questions: a woman’s age, her race, breast density as reported from mammograms, whether she has ever needed a breast biopsy and whether her mother, sisters or daughters have ever had breast cancer.

The calculator categorizes each woman’s risk as low, average, intermediate, high or very high. A five-year risk up to 1.66 percent is considered low to average; more than 4 percent is very high.

Experts Say FDA Dense Breast Proposal is an Important Step Forward

Breast imaging experts are applauding a proposed update to the Mammography Quality Standards Act by the U.S. Food and Drug Administration (FDA) that would require providers to use standardized reporting language to notify patients of their individual breast density status.

The FDA proposed rule, issued on March 28, is an important step in ensuring that women receive critical breast density information after a mammogram, said Wendie Berg, MD, PhD, a professor of radiology at the University of Pittsburgh Medical Center’s Magee-Women’s Hospital. Public comment on the FDA proposal will be accepted through June 26, 2019.

“Under the proposal, all women would be told whether they have dense breasts or not, which can guide their decisions for breast screening,” Dr. Berg said.

That has not always been the case despite laws in 37 states that require some form of breast density notification after a mammogram, said Dr. Berg, the scientific director and co-founder of DenseBreast-Info.org, a public information site that provides legislation updates and education resources for patients and health care providers.

“Many of these laws don’t actually require radiologist’s mammography result letters to tell a woman if she herself has dense breasts,” Dr. Berg said. “For example, a law might require terminology such as, ‘If your…breasts are dense’ or ‘Your mammogram may show… dense breasts’ or other general language about density. It’s been a source of confusion.”

Dr. Berg and JoAnn Pushkin, executive director of DenseBreast-Info.org, plan to submit a letter during the FDA’s public comment period commending the agency’s work on reporting standards and offering suggestions to further clarify the language in state laws and letters to patients.

In a comparison of current laws in three adjacent states, Dr. Berg and colleagues demonstrated the importance of explicitly stating whether the patient herself has dense breasts.

Currently in New York, when a mammogram shows that a woman has heterogeneously or extremely dense breasts, the notification language is, “Your mammogram shows that your breast tissue is dense,” while in Connecticut, women with the same density types receive a notification stating, “If your mammogram demonstrates that you have dense breast tissue…” In New Jersey, every woman regardless of density findings receives a standard statement beginning, “Your mammogram may show that you have dense tissue.”

Even in cases in which women have been told their specific density category, the language can be confusing, Dr. Berg said.

“We are trying to do the right thing in Pennsylvania by telling a woman her exact category — fatty, scattered, heterogeneously dense or extremely dense. The words used in the Breast Imaging Reporting and Data System (BI-RADS), of course, are ‘scattered areas of fibroglandular density’. We heard that some facilities weren’t defining that term, and that women were seeing the word ‘density’ and thinking that meant they had dense breasts.”

If finalized, the FDA proposal would apply to all states, further underscoring the need for the language in the legislation to be clear, Dr. Berg said. The FDA’s proposed requirement follows a federal funding bill signed into law in February that requires the FDA to develop new breast density reporting language to be included in patient information.

Beyond Breast Density

Recent radiologic research has provided more insight into variations in breast parenchyma among women, even beyond categories of density. In a recent Radiology study, researchers identified distinct radiomic phenotypes that offer potential for risk quantification and ultimately may augment breast cancer risk prediction models.

So far, breast density has been a surrogate for characterizing breast complexity said lead author Despina Kontos, PhD, an associate professor of radiology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia.

“It’s a measurement that has been the most easy and straightforward,” Dr. Kontos said. “But there’s more information in the images that we could be mining with modern computer analysis, especially information that may be related to how the normal breast environment could be fostering the development of cancer.”

Led by Dr. Kontos, the Computational Breast Imaging Group at the University of Pennsylvania plans to investigate how different phenotypes relate to the underlying biology of normal breast tissue.

In terms of the FDA proposal, Dr. Kontos said it is another step toward tailoring breast cancer screening to a woman’s individual personal characteristics. “Giving women the information they need is the best way to make them part of the conversation,” she said.

FDA Seeks Public Comments on Breast Density Proposal by June 26

The public is invited to access the full FDA breast density proposal and submit public comments on the measure at https://www.federalregister.gov/documents/2019/03/28/2019-05803/mammography-quality-standards-act

Web Extras

Access the Radiology study, “Radiomic Phenotypes of Mammographic Parenchymal Complexity: Toward Augmenting Breast Density in Breast Cancer Risk rel=”noopener noreferrer” Assessment,” at https://pubs.rsna.org/doi/10.1148/radiol.2018180179

Carrie’s Story

Name: Carrie
State: Indiana
Date of Diagnosis: October 27, 2011
Age at Diagnosis: 41
Stage of Diagnosis: 3A
Time from “normal” mammogram to diagnosis: 9 months
How was cancer detected?: By me and ultrasound

I am an RN, BSN, CCRN (critical care certified) and never realized that mammograms are so limited in dense breasts. My tumor was 5.5 CM and was not ‘seen’ by mammogram. I also never thought cancer hurt and my lump, which literally appeared over night, was very tender. My doctor ordered a PAP test, mammogram, blood work and chest X-ray that all came back negative. My doctor never mentioned my “dense” breasts nor suggested additional screening such as a breast ultrasound. The lump on my right breast went away and a couple months later I discovered a lump on my left breast.

It was not until August that I went to a new doctor that agreed it sounded like cysts. I also began to lose weight. The doctor ordered a CT scan of my chest and abdomen (negative). I went back again and told the doctor, “It’s not that I want something to be wrong. I just know there is.” You don’t turn 40 and loose 15 lbs unless you’re dying of cancer.” He then ordered an ultrasound and BINGO there it was – Pathology report: 5.5 cm tumor and 4/7 positive lymph nodes.

After my diagnosis I asked for a copy of the letter that was sent to my doctor after my mammogram. It said “The breast tissue is heterogeneously dense. This may lower the sensitivity of mammography – Negative mammogram with no evidence of malignancy. My tumor was 5.5 cm and they could not see it by mammogram!!

I asked my doctor to look at my original mammogram and CT scan. He said my breasts were too dense and the tumor could not be seen on either one. As a nurse I was blown away that I was never told this information. I asked all of my doctors why ultrasound is not used for patients with dense breast. I keep getting the reply “It’s not protocol”. I would be happy to help you in any way that I can to get a law in Indiana.

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