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Breast density and other lessons from graduates of the cancer academy

Hilary Fannin: Informing women of their breast density could save lives

‘If women are told about their breast density, then they can make informed decisions about further screening.’

I consulted the one-time bugle-blasting airline (which seems to have muted its own enthusiasm and silenced its horn) and found a return flight to Malaga for less than a hundred quid. I booked it and went to visit my sister. 

In their 60s, she and her husband left Dublin for Andalusia more than a year ago. Grafters both, they have found employment and are settled in a small town in a flat overlooking the Mediterranean. It is literally a one-pub town, where, nightly, three elegant horses gather in the square to drink from the abrevadero while the human inhabitants, many of them refugees from city life, wind their way down through narrow whitewashed streets to sit outside the bar for a cold cerveza

 My sister is happy in Spain. She lives in the moment, and the moments in that quiet, bleached place are good.

Cancer free

She is more than 10 years cancer-free now. More than a decade has passed since she woke up on her 50th birthday and noticed a twig-like growth above her breast, which rapidly led to diagnosis, surgery, chemotherapy and radiotherapy. It is difficult, looking at her now, immersed in her new life, to believe that those days of shivering exhaustion and fear ever really happened.

My sister’s past illness was on my mind as I travelled to see her. I had just spoken to another graduate from the breast cancer academy, a woman in her late 50s who had just finished her own treatment, losing one of her breasts in the process.

She is a composed and dignified woman, a private person who doesn’t want her name published, so I’m going to call her Jane instead.

As someone with a history of clear mammogram results from previous breast-screening appointments, Jane was profoundly shocked when, six months after another clear mammogram, she was diagnosed with cancer. A large invasive mass had developed in one of her breasts. 

 The only indication she’d had that anything was amiss was a slight pull on one of her nipples. She’d decided not to ignore this, and went to her GP, who sent her for an ultrasound, at which point the tumour was discovered. 

Breast density

All women have some level of breast density, but Jane learned then that she had high breast density. Dense breast tissue shows up white on a mammogram, as do cancer cells. The research into breast density that Jane and her family have undertaken since her diagnosis has included an explanation from an American radiologist who said: “Looking for a tumour in dense breast tissue is like looking through a dirty window. The tissue is so dense you can’t see through it.” 

High breast density has also been described as looking like a snowstorm.

During the course of her treatment and hospitalisation, Jane met other women with similar stories to tell. Jane’s response was to start finding out about breast density and to communicate her findings to others; not to be alarmist, but simply to inform.

BreastCheck, the national screening programme, saved my sister’s life, and that of many others. I am profoundly grateful to the service; it is a lifeline to thousands of women, with or without family histories of breast cancer. Jane was very clear that her story was in no way intended to undermine BreastCheck’s work.

Need for ultrasound

When I asked her what was at the nub of her research, she said: “Breast density is only visible on a mammogram; it cannot be felt. Without having a mammogram, a woman cannot tell if she has high breast density. Ironically, a mammogram cannot see cancer through very dense tissue, hence the need for ultrasound.”

In many states in the US and in Australia, she explained, a woman will now receive, along with the results of routine mammograms, a notification if she is found to have high breast density. 

“If women are told about their breast density, then they can make informed decisions about further screening,” Jane said. “Ultrasound with a mammogram leads to early diagnoses for women with dense breasts, and less invasive treatment options.”

This, of course, opens up a whole other creel of eels in this country, most pertinently the question of who will pay for the expanded ultrasound services that may be necessary. But, as Jane argues, prevention is far more cost-effective than cure.

Sitting in the sun, watching my sister enjoy life on the other side of cancer, it occurred to me to share this dialogue with you; not to alarm, as Jane said, but maybe to open up other conversations.