What Glennon Doyle and Co. Taught Me About My ‘Dense Breasts’

Who knew this would matter so much?!

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I turned 50, and BAM! A letter appeared in the post with an appointment for my first mammogram. (I live in the UK, and this is the starting age, if all has been going well up until then.) No problem. With all of my other health issues, such as type 1 diabetes, gastroparesis, and three eye diseases, this was as routine as appointments get.

A week and a half after the appointment, another letter showed up in my letterbox.

“We’d like to invite you to our breast clinic at Stoke University Hospital for further testing.”

Hmm…’invitation?’ Was this a summer pool party, with drinks included? Nope. I sighed, remembering they had warned me of this possibility at the first mammogram. According to this invite letter, 4% of women get called back. Fewer actually have cancer. More of an annoyance than a worry, I put the appointment into my phone calendar, blocking out the whole of the afternoon. A 3D mammogram, ultrasound, and even biopsy might be needed on the day. They’d decide as they went.

Ironically, the invite arrived on a Wednesday, sandwiched between the Tuesday and Thursday episodes of the, We Can Do Hard Things podcast with Glennon Doyle, Abby Wambach, and Amanda Doyle. Thanks to a recent breast cancer diagnosis and double mastectomy for Amanda, the special guest for both episodes 320 and 321 was Dr. Rachel Brem. I had already listened to Tuesday’s with interest, and on Thursday, devoured the episode even though I felt convinced I didn’t actually need it. Surely they just didn’t get a clear picture on the first mammogram? I’d had this problem with other scans multiple times over the years. Still, they had my interest. (As always.) These episodes discussed the topics of early detection, mammograms, and self-advocacy for a thorough diagnosis and treatment plan. Thankfully, Amanda had received further testing following her mammogram.

Why?

Because she had dense breasts.

According to the Mayo Clinic, who quotes the American College of Radiology's Breast Imaging Reporting and Data System, breast density is rated on a scale of four letters:

·       A: Almost entirely fatty means that the breasts are almost entirely made up of fatty tissue. There is very little dense breast tissue.

·       B: Scattered areas of fibroglandular density means the breasts are mostly made up of fatty tissue. But there are some scattered areas of dense breast tissue.

·       C: Heterogeneously dense means that most of the breast tissue is dense breast tissue. But there are some areas of fatty tissue.

·       D: Extremely dense means that nearly all of the breast tissue is dense breast tissue. There is very little fatty tissue.

You're considered having dense breasts if your mammogram report says you have heterogeneously dense or extremely dense breasts. 

Why is breast density important? Because, as I learned from Glennon and the ladies, it is harder to detect cancer in dense breasts, and there is also a higher chance of having cancer.

How do you know your density? Only a mammogram can measure it.

Again, according to the Mayo Clinic, you may be more likely to have dense breasts if you:

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·       Are younger. Breast tissue tends to become less dense as you get older. But this doesn't happen in everyone. It's possible for dense breasts to happen at any age.

·       Have a lower body mass index. Having less body fat makes it more likely that you'll have less fatty tissue and more dense tissue in your breasts.

·       Take hormone therapy for menopause. Taking combination hormone therapy to relieve menopause symptoms makes dense breasts more likely.

Clearly, since none of the above applied to me, I’d be just fine, right? (Not the first two at least, sadly. I’m 50 and carry some extra pounds. Nevermind.)

Wrong.

I walked into my Monday afternoon hospital appointment and before the greeting nurse could even show me the mammogram pictures and tell me why I was there, I blurted out, “Do I have dense breasts?” (I try to be a good student, and the podcast ladies and Dr. Brem had taught me well.)

“Extremely dense.”

Wow. Glad I asked. Sort of. Not really. But yes, glad.

“So, will you do further testing?”

I obviously was super-chill about the whole thing.

“Yes, Susanne,” she said in careful cancer-clinic soothing tones. “Let me explain why you’re here and what comes next.”

She went on to say that they would do 3D mammogram and then decide whether I needed an ultrasound and biopsy. The podcast had mentioned ultrasound and MRI as good options for people with dense breasts, so they seemed to be on the right track. And as much as I didn’t want a biopsy, I knew it could be the most definitive.

According to The Mayo Clinic, these are all options for further imaging (every test has pros and cons):

·       3D mammogram. A 3D mammogram, also called breast tomosynthesis, uses X-rays to take pictures of the breast from many angles. A computer then puts the images together. This makes a 3D image of the breast tissue.

·       Breast MRI. Breast MRI uses a magnetic field and radio waves to make 3D images of the breast tissue. It's often recommended for those with a very high risk of breast cancer.

·       Breast ultrasound. Ultrasound uses sound waves to make images of structures in the body. It shows the difference between solid masses and sacs filled with fluid, called cysts. Solid masses may be a sign of cancer. A diagnostic breast ultrasound is commonly used to take a closer look at areas of concern detected on a mammogram.

·       Contrast-enhanced digital mammogram. A contrast-enhanced digital mammogram uses contrast material that contains iodine. The contrast material can highlight possible areas of concern on a mammogram. The contrast material goes into a vein in your arm. You wait a few minutes for the contrast to reach the breast tissue. Then you have a mammogram.

·       Molecular breast imaging. Molecular breast imaging uses a radioactive tracer and a special camera to make pictures of the breast tissue. The tracer has special material in it to help find areas that may have cancer. The special camera detects any tracer that goes to the breast tissue.

It turned out I also needed the ultrasound and biopsy, as I had a discoloured area and calcification within it, in my left breast. Both could be malignant. We needed to rule that option out.

As I sat in the inner waiting area between each test, I kept thinking of Amanda and her double mastectomy and wondered, am I on a cancer journey? Polite, hushed tones seemed to suggest I was. Also, during the biopsy, the doctor inserted a marker where they took out the sample, and she informed me it is in the shape of the breast cancer ribbon. Cute, but I felt a bit like I’d been branded. I guess I was on a cancer journey?

Thankfully, a nurse phoned me two weeks later with the biopsy results, and it all turned out fine. Fibrous tissue and benign calcification, she said.

I’m so thankful for the empowering information that Amanda shared about her journey, and for the podcast as a whole for bringing on an expert (who, by-the-way, had lost her mom to breast cancer, and has had it herself. Mega expert.) I felt I could advocate for myself in an educated way, and feel confident I had received the best, most thorough care.

So, I hope you feel prompted to have your routine mammograms, boldly ask questions, and encourage the women in your life to do the same.

*Note* Men can get breast cancer, too. Unfortunately, mammograms are not routine for men, but self-checks are just as important as they are for women. Be diligent!

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