Mammograms Missed Woman's Breast Cancer, Diagnosed Late-Stage

JoAnn Pushkin took every step possible to catch breast cancer early.

She was adamant about doing her self exams, and she adhered to the recommended guidelines for annual mammograms. Alongside these screenings, she maintained a healthy diet, exercised regularly, and despite having only one aunt with breast cancer, she had no other significant risk factors.

However, at 45, Pushkin discovered a lump in her breast. Despite her vigilance, she was diagnosed with later-stage breast cancer. The reason her cancer was missed on multiple mammograms lies in her higher breast density, a factor that can obscure tumors on mammographic images.

Breast density refers to the amount of fibrous and glandular tissue compared to fatty tissue in the breasts. On a mammogram, dense breast tissue appears white, the same color as potential tumors, making it more challenging to detect abnormalities. This similarity can lead to cancers being overlooked during routine screenings.

Pushkin’s experience highlights the critical need for women to be informed about their breast density. Dense breast tissue not only increases the risk of developing breast cancer but also complicates its detection through standard mammograms. Experts suggest that women with dense breasts may benefit from additional imaging tests, such as ultrasound or MRI, which can provide clearer views and improve the chances of early detection.

There are four types of breast density, categorized by the American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS):

1. Almost entirely fatty: The breasts are mostly composed of fat, which appears dark on a mammogram, making tumors easier to see.
2. Scattered areas of fibroglandular density: There are scattered areas of density, but the majority of the breast tissue is fatty.
3. Heterogeneously dense: More of the breast tissue is dense, which can obscure small masses.
4. Extremely dense: Most of the breast tissue is dense, significantly lowering the sensitivity of mammograms.

If you’ve been informed that you have dense breast tissue, ask these questions to get information that’s specific to you, based on your personal medical history:

• What are the dense breast-related findings in my recent mammogram?
• Do you recommend additional screening or diagnostic tests for me?
• What is my overall personal risk of breast cancer, given my risk factors and protective factors?

Pushkin’s story underscores the importance of personalized breast cancer screening and the need for women to have informed discussions with their healthcare providers about breast density and appropriate imaging tests to ensure early and accurate detection. Understanding breast density and its implications can lead to more tailored screening strategies and more confidence in how you advocate for your breast health.