A Basic Fact About Breasts That Could Save Your Life: And The Force...

If you have dense breasts, as I do with fibrocystic disease, 75% of mammograms will fail to find a cancerous tumor. The only alternative diagnostic options, other than breast exams which find only large tumors, are bilateral ultrasound or MRI. Most states don't have laws requiring insurers to to pay for additional tests for the 40% of women with dense breasts. Most radiologist reports and doctors don't inform women that they have dense breasts, and that mammograms aren't reliable for them. A bilateral ultrasound will detect 3.2 cancers per 1,000 exams.

Important information about breasts has been kept from women, increasing the risk of undetected cancer.

One in eight. That’s how many women will be diagnosed with breast cancer in her lifetime,...

... many women still do not know of breast density, or if they’ve heard of it, they don’t know what it really means to them....

Breast density refers to the ratio of tissue to fat in a woman’s breast. A dense breast has more fibroglandular tissue and less fat. Forty percent of women have dense tissue, according to the American College of Radiology Imaging Network (ACRIN), which is significant because these women are five times more likely to develop breast cancer. They’re also less likely to have it detected on a mammogram.

A January 2011 Mayo Clinic study found that mammograms fail to find 75 percent of cancer in women with dense breast tissue. The primary cause of “false-negative results” in mammograms is high breast density, according to the NCI.

However, until recently, it was standard practice nationwide for doctors to keep information about breast density from patients, and as a result many people with dense breasts do not have cancer detected until it is well developed.

... dense tissue shows up as white on a mammogram and can “mask,” or obscure, cancer, which also appears as white.

image source

While mammograms were able to detect cancer in 98 percent of women with non-dense breasts,... 60 percent of cancer in dense breast was “mammographically occult or missed.”

“We as radiologists report to physicians and patients…knowing full well that if a woman has non-dense breasts we are 98% accurate but if she has dense breasts, and were to have a breast cancer, we would only be 40% accurate in our diagnosis,” he said. “Worse, by not detecting her breast cancer we allow it to grow until her next mammogram—or two or three—or until it becomes palpable, which translates to, at a minimum, double the size at which it could have been detected with imaging. However, this information is never directly transmitted to the patient.”

... this practice results “in the preventable deaths of 10,000 women each year.”

With a fatal problem of this magnitude, why would medical groups oppose the sharing of basic, but potentially life-saving, information with female patients?

... the association worried about how many unnecessary ultrasounds or biopsies would result, the extra work the deluge of additional screenings would make,...

“We knew that mammograms could miss breast cancers, but we didn’t know whether bilateral breast ultrasounds would detect enough breast cancers, with the concept that there’d also be a lot of false positives,” she goes on. “And there’d be additional anxiety for patients.

... MRIs and ultrasounds will detect more ... and, generally, increase the workload for providers. The more dense-breasted women know about the reduced efficacy of a mammogram for them, the more women will seek additional screening methods. “Beyond false positives, many radiologists believe that implementing screening ultrasound is simply not viable given the manpower it requires,”... [emphasis mine]

Tags: breast cancer diagnosis, dense breasts

Views: 242

Replies to This Discussion

Thanks Daniel. You do reference your material well, and you are discerning about the source. I fall for satire way too often. I'll just have to be more disciplined. 

Glad I'm Canadian. We get told to do mammograms after the age of 40. There is no breast cancer anywhere in my background, so I was it! If I had to rely on family history, I would have been history!

May 15th 2005, I had my usual yearly mammo.....questionable results so had to have it re-done, & then was sent to ultra sound almost right away.

May 26th, had to go in for biopsy.

May 30th, diagnosis.....two types of very aggressive breast cancer, one contained in a tumor, the second, on the outside of the tumor.

June 5th, full right side mastectomy, & then as usual with all my incisions over the years, it got infected. Antibiotics didn't appear to be very effective, so had the fluid tested. Had TWO types of infection which required TWO antibiotics, so was pretty sick before even beginning treatments!

Whatever the case, I wasn't kept waiting around, so that in itself speaks well for a smaller city, because otherwise, I'm sure I wouldn't be here.

Our medical covers everything with no questions, & I can still go in to this day & have cosmetic type surgery if I choose to......but I don't need any voluntary procedures.....had more than my share as it is. My reductions were also all covered as my size was causing a lot of other issues.

Then after all the chemo was done I had 5 years of Femara tablets, which was paid for by the Cancer Agency, so I have no idea what all that cost. I also had no idea they did that until I got the first prescription filled.

Patricia, living in a community with lots of joking around may imply healthy functioning. My medical team were supportive, first of all, and then inspired me to participate in the treatment and recognize the other options one can choose. That puts the decision making on me, and the natural consequences that come out of my decisions. They provide information, references, conflicting opinions, and then the choice is mine. They support me 100%.

Luara, I am so sorry to learn of your experiences of an assembly squashing line with little or no privacy. Having people who scold and show disrespect for women means there needs to be some changes made. Do others in your community share your experiences? Perhaps some would be willing to join together to bring about positive, healthy changes. Good old coffee klatches are a possible start. You clearly face a "systems" problem, and it needs to be changed.

Community organizing is not as hard as one would think. When I do community organizing I use the technique used by Paulo Freire.
1. gather people together with common concerns.
2. each one tells his/her story.
3. draw out the common threads
4. prioritize which problems needs to be worked on first, second, etc.
5. imagine all the possible actions one could take.
6. select an order of what to do, when, how, who, what, where, etc.
7. develop action plans and get to work.

"praxis" means thought + action.
Thought without action = maintain and perpetuate the status quo.
Action without thought = chaos.
Thought + action = a higher probability a solution can be found.

“For apart from inquiry, apart from the praxis, individuals cannot be truly human. Knowledge emerges only through invention and re-invention, through the restless, impatient, continuing, hopeful inquiry human beings pursue in the world, with the world, and with each other.”
― Paulo Freire, Pedagogy of the Oppressed

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