One of the things that has brought people to my blog are those posts that I’ve done on dense breasts, so this posting will go into more detail about this specific characteristic. Because my own breasts were very dense, I’ve had a more convoluted process with my own breast cancer diagnosis and hope that I can share information with others that can help them navigate the process and perhaps avoid additional surgeries.
Finding the tumor early is always the tricky thing with BC. Obviously, the earlier you find it, the better. The first tumor I found was very easy to distinguish – it was in the top quadrant of my left breast and I found it myself when I brushed against it one night. It was clearly defined, and I knew right away that it wasn’t normal – it was about an inch long and a half inch wide.
My breast cancer surgeon easily did a needle biopsy on the lump (as easy as it can be to have a needle stuck in your boob, but compared to some of the other procedures, it was a walk in the park) and the pathology report quickly confirmed her diagnosis of breast cancer about 3 days later. She thought, based on its size and the fact that she didn’t believe there was lymph node involvement, that it was Stage 2.
A lumpectomy was recommended, due to the Stage and initial biopsy report. The surgery was scheduled for a week later, and it was pretty straightforward with no particular complications other than the general discomfort of any surgery. My BC surgeon told us that she had removed the entire mass, with clean margins all around, and that the tumor was under 2 cm. Clean margins are good, a small size tumor is good and confirmation of no lymph node involvement is even better as it means that it’s very unlikely that the cancer has traveled to other organs.
My pathology report indicated that the tumor was actually Stage 1 (not Stage 2) invasive lobular carcinoma, no lymph node involvement and a pretty good prognosis for the future. This was great news and my husband and I were doing the happy dance when we left her office the week after surgery, when we reviewed the final pathology results with her.
THEN…..about 3 weeks after my lumpectomy, the team of my breast surgeon, radiologist and oncologist met to do a post-op review of my case. The radiologist questioned my breast surgeon on the fact that she had only removed one lump, when the mammogram films clearly showed 2 smallish tumors right next to each other which appeared to be connected by a thin tissue.
My BC surgeon called my cell (doctors always seem to call you on your cellphone when you’re driving, with the most important information that you really would like to write down but can’t ‘cause you’re driving) to tell me that because of my dense breasts which makes my mammography films tough to read, she wanted to have a breast MRI done just to be 100% sure that she had removed everything. I wasn’t really too worried, other than being scared of the MRI because I was sure everything had been removed.
I share my thoughts about how to get through an MRI in another posting (this one’s getting really long!).
BUT…the veritable shit hit the fan afterwards because….the breast MRI showed that the 1st tumor was indeed completely removed. HOWEVER, there was a second tiny little tumor down in the lower left quadrant of my breast that no one had ever found. Not during the physical exams I had by the 5 different doctors and radiologists, not during the very comprehensive mammogram or the very comprehensive ultrasound I had done for the first tumor, and not during any of the self exams I had been doing obsessively since finding the first.
And it’s all because of my dense breasts.
An MRI is very sensitive and apparently it often shows false positives for a lump, so after the MRI, I had to do another ultrasound and biopsy to confirm that the suspicious lump they found in the MRI was indeed cancerous. The ultrasound confirmed that it was a lump and that it did look questionable. The radiologists recommended a Core Needle Biopsy (more on that for another posting) where they removed cells from the tumor which then confirmed that it was another cancerous tumor.
And that meant, because it was in a whole other section of my breast, that I had to have a mastectomy after the “successful” lumpectomy, because when there are 2 lumps in one breast, they don’t want you to keep that breast. I’m not really complaining. I’m just trying to give others insights into how to be sure that they don’t have to have more than one surgery. I wound up having to have 3 surgeries all together (my original lumpectomy, bilateral mastectomy and final reconstruction), and why have 3 if/when you can reduce that number by being aware.
I think in retrospect, I would have demanded an MRI as soon as they found the first lump if I knew that it was an option, and especially now that I know what I know about dense breasts. That might have meant I would have just gone directly to a mastectomy versus having the lumpectomy and then having a mastectomy afterwards.
Dense breasts are almost impossible to read in a mammogram. You can’t really see through the dense areas of your breast so tumors can be hidden and can be missed very easily. An MRI picks up everything. MRI’s costs a lot more than Mammograms (@$3,000) which is why they’re not as readily accessible as mammograms.
So, if your doctor tells you that you have dense breasts and there are questionable results on a mammography, ask him/her if he/she thinks it warrants an MRI. And push for it, if your gut tells you to.
Great post, Claudia, and informative. I have to schedule my mammogram for this year soon, and I’ll be ready and armed with questions I otherwise wouldn’t have had before I knew all you’ve told me.
Great information, thanks Claudia. Two times now, they’ve called me back due to a “spec of dust” on the film. SPECK OF DUST??? Give me a break, so when everything turns out ok, I never trust them. thk from another dense breast lady.
What is considered dense?
Anonymous – Dense breasts have less fatty tissue and more non-fatty tissue compared to breasts that aren’t dense. Fat is easier to read on a mammogram – the technician can actually see through it and anything unusual like a tiny tumor would be visible. But when the breast is dense, the tissue is harder to see through, so sometimes things can get hidden. ASK your mammography technician and doctor if you have dense breasts. It’s a good thing to know, because it could be the reason they might be having you come back in for extra films, or to look at another section again. Hope that helps. Also, if you want more info go to Breastcancer.org and search dense breasts. It’s a very helpful site. Good luck, Claudia
Thank you for sharing Claudia all this useful information!!
Carolg
I got the dreaded call back after mammo. They spoke of dense tissue, left breast, and come in for more,pics and ultrasound in about a week dont panic they say. I panic. No word on mri or biopsy
Shannon – Hang in there, I know it’s hard to wait but if it were truly something they thought was urgent they would rush you back in (or at least they did for me). One thing you can ask is that they do an ultrasound as that seems to be better with dense breasts. Most centers will have the ability to do them. Good luck, keep me updated. Best, Claudia
I just had my annual mammogram where I had to inform them of small lumps I found between my left breast & armpit. Afterwards, my doctor messaged me I need an ultrasound on that breast due to dense tissue in that area, although nothing abnormal showed on mammo. So I scheduled for next week (their earliest appt available) & according to my chart it says they scheduled me for both a diagnostic mammo and breast US. I’m confused in that I thought they just did a diagnostic mammo. 😕
Hi Tammy, Sounds like they want to do both an ultrasound and mammogram, which is similar to my situation. Even though mammograms don’t always read well for dense breasts, they seem to want to do both mammo and US. You could call them in advance to ask why they’re doing both, or you can just wait and ask when you’re there for the appointment. Bring a notepad and ask a lot of questions about what they’re doing and why. I hope it’s nothing, and that they’re just being cautious. Best, Claudia xo
I just received the results & it stated right breast is fine. Left breast mostly fatty tissue but recommendation for palpable lump felt by technician at tail end of breast at auxiliary. But it doesn’t state anything more. Guess I’ll find out next week. :/
If the left breast is mostly fatty, the mammogram should be able to see the lump clearly……I’ll be thinking of you. Keep me posted. xo
I have had dense breasts and normally have a mammo and ultrasound. On April 19th, I went for my mammo/ultrasound and was told that I don’t need an ultrasound as my breasts are no longer dense. I am 45 and have put on quite a bit of weight so I left the appointment feeling down as I need to take the weight off. I got a call this morning requesting me to come back for more pics on the left breast. I am going back on Tuesday. My left breast is very sensitive and often aches. Any thoughts on inflammatory breast cancer and tests to request?
I would tell your radiologist about the aching and sensitivity. Then I would also ask your OBGYN about it (tell him also about the aching and sensitivity and ask about inflammatory bc) and ask him if he thinks you should see a breast specialist. If you’re still getting your period, could the sensitivity be before and during? Or is it something that comes and goes during the month? Talk to your healthcare professionals until you feel like you’ve gotten to the bottom of it. Best of luck xo
Hi Claudia
Had a mamo about one month ago and got called back for another mamo and a sono of left breast. I don’t have dense breast tissue. The doctor explained that there was no lump but there was an area where the tissue was dense in upper left quad of left breast biopsy recommended. I have to see obgyn tomorrow. Needless to say I’m scared…
Hi Ceci, I’m sorry that you are having to go through this — please make sure you have a reputable and highly recognized breast surgeon do the breast biopsy. Also review sites like http://www.breastcancer.org and write out a list of questions to bring with you and then take a lot of notes. Better yet, bring someone with you so that they can be your 2nd set of eyes and ears as it’s often very hard to remember exactly what your dr says during times like this. I hope that it turns out to be just a density problem and not anything worse, and will keep you in my thoughts. Keep me posted and best wishes. Claudia
I had a mammo ultra sound and it showed some thing so a mri was ordered with contrast was ordered. I am 230lbs and the tech have me mans bottom pants and open top, the pants did not fit b/c my ass is do big. Getting on the table trying to lay on that plastic mat with breast hanging in tubes, I couldn’t breathe laying on the table on my stomach. I just had surgery on my elbow 10 days ago, she told me that I had to lay still for at least 35 mins or more. I c ouldnt do it and struggled to get off the table using my arm that had surgery to get off my stomach. I just hurt elbow may be injuring it. I can’t do that mri
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I’m so sorry that you had such a struggle with the MRI, Vicki, it’s a scary procedure and it must be so uncomfortable with your recent elbow surgery. I hope you manage to get through it somehow and am sending love and strength. xo