Being dense about breast density

As the title implies, there are many definitions of dense and sometimes they overlap.

Feeling dense

Based on the definitions on dictionary.com, I have been dense in the sense of being “stupid; slow-witted; dull”. Now, to be honest, this definition does not fit me most of the time. I call myself a smartass, and you can’t really be one without being quick-witted. I also don’t think that people would refer to me as dull. I’m not the life of the party, but no one has fallen asleep talking to me. I, on the other hand, have fallen asleep in a room full of people. I don’t get a lot of sleep and when things are dull around me, I can’t seem to stay awake.  I guess you could say that I’m dense when it comes to going to bed at an earlier hour.

Depending on the subject matter, I can be a Category B, C, or D. The closest I get to being an Category A is maybe knowing my name and address.

Dense amounts of information

I also felt a little dense (stupid) when I started my cancer journey, but it was really the information itself that was dense, that is, “difficult to understand or follow because of being closely packed with ideas or complexities of style.” 

With cancer, there is one new term after another. There are the terms associated with symptoms and testing. There are the terms in the test results. There are the terms used when discussing treatment options and the ones used during treatments. The list goes on and on, and the speed you are expected to understand all these terms is hard to appreciate until you have experienced it. It's hard to make "informed" decisions when it's hard to keep all the information straight. However, once you learn the information, you will remember it because, unlike calculus, you will live and breath this information many years after your treatments have ended.  

The “complexity of styles” part of the definition is an understatement.  A pathology report can be a nightmare if your doctor doesn’t explain it well. It would be nice if there was a doctor’s version of test results and a simplified version below it for you, as the patient. They are your results after all.

When it comes to a breast cancer diagnosis and the overwhelming amount of information that follows, cancer and how dense I felt were about the same...a strong Category C or D.

Dense breasts

I had multiple mammograms in the process of reaching my cancer diagnosis. At no point did anyone mention that I had dense breasts. Instead, I got the news indirectly during my first ultrasound biopsy. The radiologist doing the biopsy said that he was changing needle sizes because my breast was dense and he was having trouble getting a sample.  In this situation, dictionary.com defines dense as “having the component parts closely compacted together.” The component parts refers to the composition of my breasts. The more fatty tissue there is, the less dense the breasts. Categories A and B are the least dense.

I suspect, because it was never confirmed, that my breast density was likely a Category C. When I had my diagnostic mammograms, breast density was not something that was included in the results. Luckily, that has changed in a lot of places. Look for your BI-RADS score in your mammogram results to determine your breast density. In some locations (provinces in Canada), only a Category D is reported to identify the densest of breasts.

Why is knowing your breast density so important?

The densebreastscanada.ca and densebreast-info.org websites provide the following information:

• Having dense breasts increases the risk of developing breast cancer.

• 40% to 50% of women over the age of 40 have dense breasts.

• Having dense breasts is a more common than having a family history of breast cancer. In fact, women with extremely dense (Category D) breasts are four to six times more likely to develop breast cancer than women with fatty breasts (Category A).

• Density is not related to size or firmness. You cannot tell if you have dense breasts by touch. Women need a mammogram to determine breast density.

• Mammograms miss about 50% of breast cancers in the densest breasts (Categories C and D). Dense breasts make it harder for a radiologist viewing your mammogram to spot cancer because dense breast tissue shows up as white and so does a cancerous tumour. Fatty tissue shows up as black on a mammogram, so if there is mostly fatty tissue, it’s much easier to spot the white of a cancerous tumour.

• Other screening tests, such as ultrasounds or magnetic resonance imaging (MRIs), when used in addition to mammography, substantially increase detection of early stage breast cancers in dense breasts.

Personally, I had multiple mammograms and ultrasounds before I had an MRI and it wasn't until I had an MRI that it became abundantly clear that there were signs of cancer in three-quarters of my left breast. In fact, after my mastectomy, it was discovered that the cancerous area was even larger than they thought. 

Initially, I didn't know any of the above information; however, I like to think that, as far as knowing about breast density, I have moved from a Category C or D to a B.

How to be smarter about cancer

Here are some suggestions that may help you feel less dense about cancer:

• Don't be rushed and ask questions. There’s a lot of information to learn in a short time, and the subject is not something you thought you would ever need to know. If you don’t understand something, take a deep breath and ask questions. Better yet, ask for pictures/drawings until you do understand. It’s your body. You, of all people, need to understand enough information to be able to make informed decisions.

• Have regular mammograms and, if necessary, supplemental screening. Look for your breast density in the results.  If your breast density is a Category C or D, you have dense breasts and should talk to your doctor about having supplemental screening (for example, ultrasound or MRI) to ensure that you don't have cancer that was not detected on a mammogram.

• Advocate for change. If you live in a location where breast density is not included in mammogram results, find out what you can do to get this practice changed.

Resources   

Go to densebreastscanada.ca, mybreastscreening.ca, and densebreast-info.org for more information. There are great mammogram images on these sites that show how breast density affects what can be seen and not seen. These sites also have suggestions about how to work with your doctor to get the tests you want and deserve. There are also details about what is wrong with the current breast screening guidelines (starting to screen at 40 instead of starting at 50) and the taskforce that is making those recommendations.

Remember, don't be dense when it comes to your breasts.