On Being Dense...

A couple of years ago I felt a lump in my breast, and went to see my gynacologist. Perimenopausal (read 'changing hormones') and with a family history of breast cancer, I was sent for a mammogram, an ultrasound and an MRI. I was 45 and hadn't had a mammogram before.

The radiologist told me that although my lump was a simple cyst, I did have very dense breasts and should have a yearly mammogram as my breast cancer risk was four times higher than most.

The MRI confirmed his findings, no cancer detected, and I was much relieved.

Fast forward to two weeks ago and I discovered another lump, much bigger this time. I consoled myself (over the 10 days leading to an appointment with the gynacologist) that its size and the fact that it had appeared suddenly meant it was unlikely to be cancer which surely grows slowly. I regularly self-examine.

Thankfully the gynacologist also believed it to be benign. "It's oval and it moves a bit" he said happily.

The next week I had an automatic appointment for a mammogram, ultrasound and possible aspiration (draining the fluid out). 

And this is where things get trickier.

You see, I have a history of medical interventions that have proven with hindsight to be unnecessary and to have caused more damage than they did good. I can talk about high doses of steroids, teeth extractions, 'cleansing herbs', courses of antibiotics, being told a splenectomy was necessary - all recommended by experts in their field. All of them (bar the splenectomy which I narrowly avoided) impacted badly on my health, and were the result of being treated 'by the book' rather than as an individual.

I was thinking a lot about mammogram; about how much it had hurt last time, about the fact that it had never picked up my sister's breast cancer when an ultrasound did. I also know there are radiation risks associated with mammogram, but to be honest, they weren't playing on my mind. I was thinking: my body, my choice. I read up about dense breasts and mammogram.

I have small breasts. Smaller breasts are more likely to be dense as they have less fatty tissue and are more glandular. And mammograms are less likely to find the cancer in dense breasts. In fact "having dense breasts is the strongest predictor for cancer being missed by mammography" says Dr. Kathy Schilling in the linked article above. Also, a recent study found that breast density should not be the only factor governing cancer screening.

So I decided to have the ultrasound but not the mammogram on this occasion, (I might have the mammogram later this year, maybe not). I felt good about my choice because given the dense breast factor, I wasn't just delusional or in denial, I was making a rational, if personal, decision.

I had to confirm this decision three times at the hospital with three different people, as, of course, mammography is generally a very useful diagnostic tool and is recommended. But finally I got to have just my ultrasound, where the safe nature of the 14 mm cyst was confirmed. The breast has a lot of other (safe) cysts in it (typical of a dense breast). So, I pondered whilst lying on the radiologist's table, that my cyst has 'cystas'.

And so do I! This blog post is for all those of you (sisters, obvs) who may have small, dense breasts, or may want to check out whether or not yours are dense via mammogram with your doctor or consultant. Then you can make the screening choices which are most likely to work for you.

Finally, having thought I would have an automatic aspiration, I was given a choice. The radiologist said there were only two good reasons to have one: 1) If he found the cyst suspicious, and 2) If I asked him to.

I wanted to get out pretty quickly so decided against.

I'm going to ask about different screening options next time and possibly opt for an MRI. 

Have you had any experiences with screening options and lumps?


Karen Dobres

Chief Freedom Fighter