Being Dense about Cancer

Finding a tumour in a dense breast is like finding one house in a densely-populated area.

---

Have you ever been called dense? I have…in multiple senses of the word. 

Dense, the feeling
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. 

Dense, the 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, the information just keeps coming and it’s likely to be totally foreign to you. Most people don’t know anything about sentinel and axillary nodes, which is understandable. Learning cancer terminology is on a need-to-know basis. If the time comes when you need to know it, you’ll learn and remember it because, unlike calculus, you will actually use the information to make decisions about treatment.   

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. 

Dense, the 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 National Cancer Institute explains that “Breasts contain glandular, connective, and fat tissue. Breast density is a term that describes the relative amount of these different types of breast tissue as seen on a mammogram. Dense breasts have relatively high amounts of glandular tissue and fibrous connective tissue and relatively low amounts of fatty breast tissue.” 

But what does this mean? Why is it important? 

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

• 40% to 50% of women over the age of 40 have dense breasts.
• Having dense breasts is a greater risk factor than having a family history of breast cancer. In fact, women with extremely dense breasts are four to six times more likely to develop cancer than women with fatty breasts.

• Density is not related to size or firmness. You cannot tell by touch. A mammogram determines density.
• Mammograms miss about 50% of breast cancers in the densest breasts. 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 potential cancerous tumours.
• Other screening tests, such as ultrasounds or magnetic resonance imaging (MRIs), 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 that made it abundantly clear that there were signs of cancer in three-quarters of my left breast. Don't worry. This is not likely to be your experience.  
 
How to be Smarter about Cancer
Here are some suggestions that may help you feel less dense about cancer.

• There’s a lot of information to learn in such a short time. If you don’t understand something, ask questions or 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 ask your doctor about your breast density results. If they are included in your report, and you do have dense breasts, talk to your doctor about what additional steps should be taken to ensure that, if you develop breast cancer, it is detected early. This could include more frequent trips to the doctor for a breast exam or having an ultrasound/MRI in addition to a mammogram.
• 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. 
  • In Canada, three provinces (British Columbia, Manitoba, and Nova Scotia) do not include breast density in their mammogram results. An organization called Dense Breasts Canada is trying to get this practice changed. There’s even a petition on their site where you can show your support.
  • In the United States, there is currently no federal legislation or regulation that requires breast density information to be included on mammogram reports; however, there are 36 states where it is required. Find out if it is a requirement in your state.   
• Go to sites like densebreastscanada.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.    

​With breasts, it’s better to know than not know if you're dense.