"When Mammograms Lie" an article by reporter Sharon Kirkey of Post Media

Last Friday in the Vancouver Sun there was an article by Sharon Kirkey about how mammograms miss cancer.  I contacted her and the full article can be found on line here.  I encourage you to go and read and look at the great mammography images of dense breasts that Sharon has posted.  You will see why looking for cancer in dense breasted women is like looking for a snowball in a blizzared.   I forget where I read that but love the imagery as it is so much more visual than "white on white"!


http://o.canada.com/health/when-mammograms-lie-how-cancer-can-sneak-past-our-greatest-screening-techniques


As I know by now, I am not alone in my experience.  Sharon Kirkey mentions the private member's bill that MP Patrick Brown put forward and that is now stalled in the senate.  Mi-Jung Lee and Melanie Nagy have both contacted MP Brown but it is our senators that we need to light a fire under to get them to pass this bill.  You can read about the bill here.  I am going to contact some of the BC senators and see if I can set up a meeting with them.


Sharon Kirkey also quotes Dr. Christine Wilson of BC Screening Mammography who says there limitations with mammography as with all technology.  That is okay, most things have limitations but if women were informed they have dense breasts they could do something about it, namely get an ultrasound or an MRI.  Had I been told my breasts were dense, I would have paid for an ultrasound privately.


Most alarmingly for me in the article is the attitude of Dr. Steven Narod, a world leader in the field of breast and ovarian cancer genetics at Women’s College Research Institute in Toronto.  From Sharon Kirkey's article, Dr. Narod says, "It's putting a lot on women's plates.  I think we've already got enough fear of breast cancer in the population without exacerbating it."  He goes on to say, "Should we make the situation worse by telling women they have highly dense breasts? What’s the response? Get an MRI? An MRI is an expensive test. Is that where we’re heading?  I think it should be clear-thinking scientists and policy people versed in healthcare evaluation to be making these recommendations", and not a political response to pressure from advocacy groups, he said.  This makes me want to scream - not a political response from advocacy groups!  He clearly hasn't seen what advocacy groups in the US have done to change the rule in 14 states!   Does it all come down to money!   Is my life and the lives of all the other women with dense breasts not important?  Now with late diagnosis, I live daily with the fear of recurrence not to mention the increased risk of recurrence.


The article also explains that, "one concern is that ultrasounds and MRIs may pick up too many 'false positives' — abnormalities that lead to more anxiety-provoking tests and painful needle biopsies and other investigations for suspicious spots that turn out to be entirely normal."  Let me tell you I would MUCH RATHER have been a false positive than then false negative I was.  The enlarged lymph node on my left side (noncancerous so far) turned out to be benign and although it is was somewhat stressful waiting for the biopsy and the results it was NOTHING compared to what I have lived through and continue to live through.


A lot of people are visiting this blog but not signing the petition.  I want to clarify that I am totally supportive of women going and getting regular mammograms, I can't tell you how important this is.  Just be armed with the knowledge from someone who learned the hard way that if you have dense breasts the cancer can be missed.  All I would like to ask, is that if you have learned to ask, "Do I have dense breasts?  Do I need further testing?"  from reading this blog or seeing the pieces on CTV please sign the petition.  Please help others and help make a change for the women of British Columbia.

Some Interesting Numbers

Please follow along with a little bit of math:


There are 2.46  or rounded, 2.5 million women in Canada between the ages of 40-49.
Source: Stat Can website


I had first heard that 30% of women in that age range have dense breasts, so then approximately 750,000 women in Canada between the ages of 40-49 have dense breasts, however after more research I found a review of this  study called "The Relationship of Mammographic Density and Age: Implications for Breast Cancer Screening" by Checka CM, Chun JE, Schnabel FR, Lee J, and Toth H., reported in March 2012.  In the summary of the results, they found, "74% of patients between 40 and 49 years old had dense breasts.  This percentage decreased to 57% of women in their 50's.  However, 44% of women in their 60's and 36% of women in their 70's had dense breasts as characterized on their screening mammograms."


Let me do the calculation again, if we take 74% of the 2.5 million Canadian women between 40-49 then an astounding 1,850,000 or 1.85 million women have breast density that could impact the accuracy of mammogram screening.

In the book about breast cancer I was given to read it says approximately 25% of cancers are missed in women between the ages of 40-49.  Using 25% to calculate then, 462,500 cancers could potentially be missed by screening mammograms.


(If you want to be conservative and take the 30% density figure, and the 25%, that is 187,500 women at risk).




The National Cancer Institute has a page on mammograms and explains both false postives (radiologists think the mammogram shows a cancer but upon further testing no cancer is present) and false negatives (a mammogram appears normal although breast cancer is present).  They state that overall screening mammograms miss about 20% of breast cancers and the main cause of false negatives is high breast density.  They also explain that false negative results occur more often in younger women because younger (premenopausal) women are more likely to have dense breasts than older women.


Please don't get me wrong, although about 25% of cancers are missed in women 40-49, there are many cancers that are detected by mammograms and mammograms do save lives.  Please make sure you go and get your mammogram but also to ask about your breast density.


For the "heads up" of knowing to ask, which I never knew to do, I ask you please sign this petition.




Other interesting information can be found at:
Canadian Breast Cancer Foundation website - Breast Cancer in Canada, 2013

Check out the picture from Breast Diagnostic Centre

I received permission from the Breast Diagnostic Centre in Washington state to post the picture on my website and have inserted it on the early post.  If you go back to that post you can see what I mean about "white on white" and cancer being much harder to identify on mammograms in women with dense breasts.
Breast Diagnostic Centre post

Breast Diagnostic Centre (BDC) - Washington State

 In rereading my initial post I realized it might be helpful to include a picture of what dense breasts look like on a screening mammogram.  From a google search I found a good picture on the Breast Diagnostic Centre website.  This medical centre has kindly granted me permission to post the picture below from their website on to this blog so you can see what I mean by the "white on white"!

The BDC website says that, "While there is no law yet in Washington State mandating mammography facilities to notify patients of their breast density and the option for supplemental ultrasound, it is clearly on the horizon.  BDC (their clinic) is taking a proactive stance by notifying patients of their breast density via their mammogram report and providing education and the latest technology available, including 3D Mammography (tomosynthesis) and Ultrasound Breast Screening."  Imagine the difference we could make if we could get the same proactive stance here in British Columbia and have women be notified if they have dense breasts.  I can tell you that my life for one would be very different!

Mi-Jung Lee has a link to a website in the USA called Are You Dense?  The site's mission statement reads, " Are You Dense, Inc. is dedicated to informing the public about dense breast tissue and its significance for the early detection of breast cancer."  The site has lots of information and a story about a doctor who ended up with Stage III breast cancer.  I can definitely relate to her experience!  Between May 17, 2013 and November 25, 2013, I had 8 "dose-dense" sessions of chemo - 2 weeks apart,  28 days of radiation and then a modified radical mastectomy.  On the 'Are You Dense?' website you can learn the fourteen states that have density reporting legislation to protect women from delayed diagnoses.  Let's get the word out and try to make BC the first province to have the same kind of legislation.

Why start a petition about screening mammograms and dense breasts?

North America has one of the highest rates of mortality from breast cancer than other places in the world.  For example, the mortality rate is about twice as high as in China - Hong Kong. (See the "Geographical variation" on the Breast Cancer of "Net Doctor").  You can click here to see a graph showing different countries breast cancer mortality rates on the World Health Organization website. 

Through the "Run For a Cure" fundraiser, thousands of miles have been run to raise funds for a cure but despite much research and progress there still doesn't seem to be one!  Through the skill of surgeons, often in conjunction with chemo, tumours can be removed from the breast and women given varying chances of survival.  It is the tumour that is small, localized and well defined, which has been discovered early by screening mammography, that gives a woman the best chance at survival.

Successful mammography depends on the relative densities of breast tissues and the tumour.  Dense breasts make the tumour more difficult to see because they show as white as does the tumour.  The white on white thus makes mammograms harder to interpret.  Around 30% of premenopausal women have dense breasts, which may help explain why one in four tumours are missed by screening mammograms in women between the ages of 40-49.  All women are important, don't get me wrong, but when cancer is missed in young women the consequence can be tragic when children are left without mothers!


If I am successful with this petition, I hope to see there become a formal requirement in British Columbia that following a screening mammogram, a woman is informed if she has dense breasts.  She may then, after discussion with her family doctor, seek imaging by methods which do not depend so much on tissue density, such as ultrasound or MRI.

I hope you feel you can sign my petition.  To do so, click on the link in the right hand column.  Together we might be able to make a difference!


For those interested, if you want to make your own graph on different cancers you can use the WHO statistics by clicking here.