Breast cancer: Know how dense tissue affects screening
“Reading a normal mammogram is like looking for a pine tree on a prairie. Reading YOUR mammogram, was like looking at a forest of pine trees, and trying to decide if there is an ugly one.” I will never forget these words spoken by my oncologist, Dr. Robert Shreck, shortly after my breast cancer diagnosis. He was trying to help me understand how my cancer could have gotten so advanced before it was detected.
My name is Bridget Pargulski, and I am a breast cancer survivor and founder of the Iowa Army of Pink. I founded this group to organize and enlist help in spreading awareness on the issue of dense breast tissue and its impact on mammography and breast cancer risk. I did not want what happened to me to happen to anyone else. But I would learn that it was happening to other women, far too often.
I never missed a mammogram. I did self-exams. I did everything that I was supposed to be doing to find breast cancer early, even though breast cancer did not run in my family. So how was my cancer not diagnosed until it was stage 3 and advanced into my lymph nodes? Turns out, there is a very simple explanation. I had extremely dense breast tissue which makes it hard or impossible to see cancer on a mammogram. This is a fact that I did not understand, until it was too late.
According to breastcancer.org, “Dense breast tissue makes it harder for doctors to see cancer on mammograms. This increases the risk that cancers will be missed.” The American Cancer society warns “screening mammography miss(es) about 1 in 8 breast cancers. Women with dense breasts are more likely to get a false-negative result.” I would later learn at the Mayo Clinic that my cancer had likely been there for five years! That means I had four mammograms that were interpreted as “normal” when I did actually have cancer.
After learning that I had extremely dense breast tissue that delayed my diagnosis, I wanted to learn everything I could about breast density. I learned that it is very common. According to the Mayo Clinic, “about half of women undergoing mammograms, have dense breasts.” Approximately 40% of women are in the "heterogeneously dense" category and 10% are in the "extremely dense" category. The other 50% of women fall into either the "fatty" or "scattered" categories, which are not considered dense.
Breast density is simply fibrous and glandular tissue in your breast, as opposed to fat. It is normal tissue in the makeup of our breasts. However, it reflects white on a mammogram, and so does cancer! Some have compared reading the mammogram of women with dense tissue to looking for a snowball in a blizzard.
I was also very surprised to learn that having dense breast tissue puts you at higher risk for getting breast cancer. Memorial Sloan Kettering Cancer Center reports, “People with the highest density are 4-6 more times likely to get breast cancer than people with the least dense breasts.” This level of risk is second only to having the BRCA gene.
Dense breast tissue is not something you or your provider can feel. The ONLY way to know if you have dense breast tissue is by getting a mammogram. The radiologist will determine in which breast density category you are, and, thanks to advocacy efforts of the Iowa Army of Pink, your density category will be reported to you in your mammogram result letter!
The Iowa Army of Pink is now 10 years old. Our efforts have had an undeniable impact on breast cancer screening in Iowa. For the first five years, we worked full time in our role of advocacy. We felt it was very important to get breast density information into the hands of women directly! We spent countless hours at the State Capitol educating legislators on the issue and urging them to pass a law that would require radiologists to inform women of their specific breast density category.
Iowa’s breast density inform law was passed in 2017 and went into effect in 2018. Breast density information is now provided in the mammogram result letter that comes in the mail directly to the patient after her mammogram. This notification also informs women that having dense breast tissue increases her risk of getting breast cancer. Women are encouraged to speak with their provider to determine if they need an additional test that is not impacted by density, such as whole breast ultrasound or MRI, to find cancer earlier.
After accomplishing our goal of getting breast density information into the hands of women, we turned our focus to educating on this issue. We became a 501(c)3 nonprofit. We have welcomed every invitation to speak and share our message. We have spoken at conferences, health fairs, farmers markets, lunch and learns, medical schools, and for four years, we have had a presence at the Iowa State Fair educating thousands of women in the Varied Industries Building. We have had our materials translated into Spanish and produced an educational video in Spanish to help educate our Spanish speaking population.
Having dense breast tissue is a double edge sword. We are at a higher risk than average to get breast cancer, and our cancers will not always be visible on mammography — even 3D mammography. This can delay diagnosis, making it harder to treat. No one should die of breast cancer, but early detection is critical.
We have a continued commitment to spreading awareness on this issue to as many in Iowa as we can. The Iowa Army of Pink is an all-volunteer organization. We need your help. We would like to have a presence in every county in the state of Iowa! If you would like more information about the Iowa Army of Pink, or would like to join us as a volunteer please email us at Iowaarmyofpink@gmail.com
For more information on breast density, please visit our website, www.iowabreastdensity.org, or a national website, www.densebreast-info.org.
Bridget Pargulski is the founder of the Iowa Army of Pink.
This article originally appeared on Des Moines Register: In breast cancer screening, dense tissue matters
