“Am I Dense?” and Other Questions at My First Mammogram

Mammograms. The test we love to take? NOPE. But the test we need to take? YUP.

Currently, there is a debate brewing about whether women should go for The Booby Squishing before the age of 50, but many doctors hold steady at age 40 for a first mammogram. If you are in a higher-risk category for breast cancer due to family history or if you are over 40 (or any other thing I’m missing since I’m not your doctor) please find out where you are on the density scale for one very important reason: Dense tissue shows up white on the mammogram just like tumors, and dense tissue puts you at higher risk for future tumors.

Here are some of the things I learned at my mammo:

Mine was a “screening mammogram,” and right away the technician told me I have “extremely dense” breasts and should not be alarmed if I got called back in.

Okay. Sounds reasonable. Get called back after a cancer screening but… do. not. freak. out?

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During these baseline tests, what you and your doctor need to know is whether you have dense breasts or fatty breasts. Or more accurately, dense or fatty tissue. This is not an aesthetic or superiority thing at all. Don’t fall into a body image crisis because of the words being used for identification, or we will all flip out. Once again: It is simply a question of connective tissue, and whether yours is more “fatty” tissue or more “dense” tissue. It is brown eyes or blue, flat feet or high arches.It has nothing to do with lumpy, either.

Most importantly, the only way to determine breast density is with the mammogram, not by the feels. I read an analogy somewhere: that feeling for a tumor in dense tissue is like trying to find a softball in the snow. For me, and my apparently freaky dense tissue, this could be like trying to feel for a tiny snowball in a New England blizzard.

It is important to know that cancer risk actually rises if you have this dense tissue.  All of this might especially apply to pre-menopausal women, because the tissue density tends to (but does not always) decrease after menopause. (Like everything else concerning our female bodies, it is not a rule and can vary greatly from woman to woman.)

Research has shown that dense breasts:

  • Can be 6 times more likely to develop cancer
  • Can make it harder for mammograms to detect breast cancer; breast cancers (which look white like breast gland tissue) are easier to see on a mammogram when they’re surrounded by fatty tissue (which looks dark).

F1.largeSo get out there and educate yourself!  Don’t be dense!  Or be dense! Or be fatty! Just know! Here is a good link to get your started:  Are you dense?  Another one here.

Predictably, in my case the technician was right: I did get the call to come back in, and no, I did not worry too much after that call. But going in for the appointment was really be shit on my nerves. They took a few more mammogram films and then told me to wait. Then, like water drip torture, they called me back in not once, not twice, but three more times for more shots. Or was it four?

And these tests ranged from extremely unpleasant to downright painful. The screening mammogram was a breeze, even if not necessarily a good time. But the follow-ups were not easy, in part because of where they were looking in the density that is my breast. In the eighties my breasts were “in”: cones! If the style is ever flat boobs you can cou

Because of my density issue, the doctor called me back for an ultrasound. I knew this was where I was heading. The ultrasound can “see” things the mammogram cannot in the dense tissue.  So why not go straight there?  I’m not going to pretend to have a full understanding of this though I will say that the doctors and technicians and my own research have me convinced that the ultrasound is no substitute for the mammogram, and that you really should have both.

Although the ultrasound is more physically comfortable, it takes longer for the ultrasound tech to do this procedure. After that the radiologist comes in to have a look because they can see the image slightly better in real time. After about a half an hour of this I start to yearn for one of my nerve pills.

The doctors and technicians don’t tell you right away what they have seen. Instead, you have to wait for your doctor to get the report and call you. Oi!

Luckily, my doctor called the next day, reducing wait time, but unfortunately the doctor wanted more tests: this time, a biopsy might be included.  I was now solidly out of the fun zone, because no matter how many things you read that say a needle biopsy is not a big thing, it feels like a very big thing, especially if you have a fear of needles and/or pass out when simply trying to give blood.

I went in for the next round of tests–a somewhat painful mammogram for more images (this time 3-D!) and more ultrasound images–resulting in the decision to go forward with the biopsy.

I closed my eyes, and had a great doctor who talked me through the biopsy, and they were not lying to me when they said the core-needle biopsy procedure is not that bad. This is a pretty common procedure. You get real numb real fast, and though the noise is fucking dreadful they do tell you when it’s coming. The pain isn’t too terrible in the days after. I experienced some bruising and discomfort, but nothing truly awful. As an added bonus, they leave a silver clip in there which I now like to think of as my special piercing.

Of course everyone is different and no one should feel bad about how they feel or react to this kind of thing – not ever. None of this is easy, and however we get through it is okay.  My hope is that by openly talking about this process, there may be less uncertainty if you find yourself or someone you love in this place.

So really, let’s not forget that a pink ribbon is no substitute for education and progress.

In addition to the links above, here is a handy Q & A with diagnostic radiologist Carol Lee from Memorial Sloan Kettering.

Finally, be sure to know how you are protected under the law, thanks to the efforts of a heroine from Connecticut.

Please feel free to use the comment section to talk about your mammo or density experiences. The more we know, the less we have to fear.

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