Hello bOObs Bloggettes:
I always have a lot of responses to my posts on the dense breast tissue (DBT) issue, so I thought I’d repost this old blog:
DBT is a HUGE consideration during breast cancer (BC) screening and one women should be well-informed about prior to screening.
First know this: 90% of us have some degree of DBT. A woman’s breast density level is determined by what a radiologist sees on her mammogram’s X-ray. Degrees of density are broken down like this, in ascending order of density: 10% of us have “fatty” breasts, which are almost all fat (I have yet to meet one woman who falls into this category); 40% have “scattered” density, which is still considered “low” density; 40% have “heterogeneous” density, which is on the high side; and an unlucky 10% are in the upper category of “extremely” dense tissue. For the latter, the mammogram misses up to about 50% of BC — and for this reason the mammogram is not very helpful for these women. For the lucky 10% of women who have all fatty tissue (again, whoever they are), the mammogram works pretty darn well at finding BC — and radiologists don’t have to increase the radiation load in order to find any cancer.
What did I mean by that last statement regarding radiation load? Well, ladies, realize this (which I didn’t until I undertook this project): The higher the degree of dense tissue in your breasts, the more they have to crank up the radiation during screening to see through the tissue. And it can reach pretty high levels pretty darn quickly. But why do they have to crank? you ask. Because dense breast tissue appears white on a mammogram — and so does the cancer. Cranking the radiation helps the radiologist read the mammogram more accurately (but if he/she still can’t differentiate, you’re asked back for another mammogram with even more radiation).
Who knew, right? Once again, there goes our Informed Consent right out the window (see blog on Informed Consent).
I’ve had several experiences with regards to DBT and mammography. The first was being told I had DBT in the first place. All I heard at the time was: “Oh, you have dense breasts.” But then they failed to tell me what the heck that meant and why I should care (and you should care). All I thought instead was “Look, I don’t care if my breasts are made out of Play-Doh as long as I don’t have cancer. Can I get out of this awful ugly gown and get out of here please??? My dense breasts are freezing!!!”
Another DBT event was a few years later and a long time ago when my breasts were even more dense than they are now. The nurse told me as I was getting dressed that, while the radiologist couldn’t see very well through the DBT, they thought there might be something suspicious and I needed to come back for a second mammogram — which of course scared the bejesus out of me for the next 2 weeks until the appointment! I was an absolute mess and never want to go through that again. In the end their answer was: Sorry, it was nothing. Argh….
The Third Encounter of a Weird Kind was the last mammogram I had 7 (or so) years ago. I was standing there minding my own business, my breast in a veritable vice grip, wondering why the heck I was doing this “squish and radiation” thing to myself every year or so, when the rad tech came in and announced that my breast wasn’t flattened enough for the exam (there’s some type of algorithmic blah blah blah that they use to figure out the Optimum Squish ratio to Radiation used (I think it’s right before the woman starts screaming bloody murder)). I pled with the rad tech not to crank it down anymore because the pain was already excruciating. Mais non! She cranked it down anyway. YE-OWWWWWW!!
Little did I know at the time — but I have learned since from a radiologist — that what had probably taken place behind the leaded wall that day was that they had already taken X-rays of my breast, seen that they were less than optimum, and now had to flatten my breast out more and then take more X-rays! In doing so, I was getting at least twice the radiation than an “average” mammogram just based on getting two sets of mammogram X-rays — and that doesn’t count the increased amount of radiation they were shooting through my dense breasts to find any cancer. Informed Consent? Gone like the wind…
As a reminder, women in the higher density categories of “heterogeneous” and “extremely” should absolutely consult with their doctors and plead (if necessary) for an ultrasound in addition to the mammogram — or if you can talk them into skipping the mammogram and go right to the ultrasound, go for it. In fact, I’d ask for one if I were in the lower “scattered” category too, because any DBT can potentially mask a cancer.
bOObs BOTTOM LINE: Women with DBT have more chance of contracting cancer in their lifetime — and the denser your breasts, the more likely it is. We will look further at this increased cancer risk in the next blog and the conundrum of DBT — and you’ll see for yourself the shocking information I uncovered in the medical literature .
Blog at you soon, thanks for reading and helping to spread the word! (Please see the “share” links below.) And we’d love to hear comments from you! (see below as well)
Stay healthy,
Megan
Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts
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2 Comments
Gale · September 9, 2022 at 11:19 am
I had broken leg and broken wrist which means multiple multiple x-rays in 2020… I went to Sally jobes and Golden Colorado and they did a 2d mammogram called me back for a 3D mammogram because I have DBT. Called me back for an ultrasound. Which was inconclusive so they wanted to do another mammogram. I put my foot down I told my OBGYN that I was not doing any more mammograms and that if he does not agree we can agree to disagree and I can go my way. But I would sign off on any and all that I will never Sue let’s do an ultrasound and call it good. Ultrasound showed multiple milk ducts which the mammogram was bruising and DBT. Doctor in St Anthony’s breast said no cancer and agreed breasts were healthy. That is how I will handle each and every one of the mammograms necessary for insurance purposes. By the way I have seen this OBGYN for 45 years.
Megan Smith · September 14, 2022 at 1:22 pm
Hi Gale. Wow, what a story! So sorry you had to go through this. I’ve heard so many horror stories about BC screening I can’t even tell you. Thank goodness you told them to stop. I’ve blogged about this before but the mammogram itself, as you discovered, can do harm to the breast and traumatize the tissue. This in itself can be dangerous, I’ve found out personally.
Good luck to you and thanks for the comment, Megan