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]

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Replies to This Discussion

"Something not right!" A chilling thing to hear. Your cancer ordeal is over, at least that is our fervant hope; yet you have other challenges. I admire your fortitude! Thanks for your guidance and support. 

Patricia, I have found you to be an excellent source of information and an inspiration throughout this whole experience. Thank you so very much. 
I agree that mammograms are not the torture they used to be, thankfully. And experiencing cancer has been a benefit in so many ways, i.e. better relationships with my three children, four grandchildren, and five great-grandchildren, and the pure joy of waking up each morning. There is a true joy in living. I like being an elder to my little tribe, and they flourish totally without violence in their homes. I never thought I would witness this! 

I like the word diligence. And persistence in reminding others to have regular check ups. I look forward to seeing a true prevention of cancer. Treatments do get better with valid research and awareness of the public to invest in prevention. 

The way they treat you at the place where I get mammograms is so disheartening.  It's an assembly line atmosphere, only instead of assembly, it's a squashing line.  Complete with large glass windows to give you an appropriate sense of privacy - or the total lack of it.  And scolding attendants.  It seems to show an unsubtle disrespect for women. 

Still, all this talk of breast cancer did inspire me to ask my doctor for a mammogram prescription. 

I live in a small town too.  Unfortunately there isn't much choice in imaging places here.

Breasts are supposed to be sexy, and the contrast between that and the mammogram experience is part of the disheartening aspect.  All those older women around partially undressed and being treated in an VERY unsexy way. 

Where I am, it's the medical insurance that determines what tests can be ordered and when and for whom and under what circumstances.  The doctor or nurse practitioner does not have a say.

This is what the US Preventive Services Task Force recommends.  This is their summary.

This is how the AAFP summarizes: 

Although magnetic resonance imaging shows promise as a screening tool in some high-risk women, it is not currently recommended for general screening because of high false-positive rates and cost. The American Cancer Society recommends annual magnetic resonance imaging as an adjunct to screening mammography in high-risk women 30 years and older.

The screening is influenced by whether the known breast cancer mutations are suspected in the patient's  family lineage.  I think if they are BRCA + the MRIs are ordered.

It's distressing that "

Half of U.S. women 40 and older do not get annual mammograms to screen for breast cancer, and nearly 40 percent of women 50 and older do not get the recommended biannual screenings, even though they have insurance.

Sentient, your comment includes valuable information and I reposted one on Twitter, which also goes to Facebook. What you wrote is full of additional information. May I repost your comment on Twitter with attribution to Sentient Biped? or how do you want me to manage attribution? 

"The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. "

My cancer was found two months after my 77th birthday. I still have yearly mammograms. 

Joan, feel free to re-post!  I try to make sure I reference most things I post, and as often as I can try to use reputable sources.  Sometimes it's hard to find "unbiased" sources, because all sources are subject to biases in one direction or the other.  But we read and process the info as best we can, and somewhere in there is "truth" or something approaching "truth"

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. 

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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