09.01.14 / Breast Density / Author: admin / Comments: (3)
As mentioned, an MRI uses magnetic resonance imaging to provide pictures for a Radiologist to interpret. It is basically a very large magnet. In order to have an MRI done, you need to remove all metal objects, even metal clips on bra straps can be pulled in! Apparently if you Google ‘strange objects in MRI’, there are many pictures of MRI’s with such things as floor polishers that have been sucked into them! A very expensive exercise I imagine.
Once you are metal free, you need to have no clothing on the top half, wear a gown and paper hat…. very glamorous. They will also put a cannula into your arm. This is so they can inject a contrast agent during one or two of the scans. You then lie face down on the bed, like when you have a massage, except your boobs are hanging down through the bed (also very glamorous!). The good thing about being face down is that you don’t really notice going into the machine. The bed moves really smoothly too. There is plenty of light and therefore less potential for claustrophobia. Personally, I closed my eyes and went to the beach. They also hook up the cannula to the components that will inject the contrast agent, this is all done remotely as they can’t enter the room once they start all of the scans.
So you are face down on the bed, face is in padded hole, boobs hanging down. You’re arms will be stretched out in front of you. If you are not flexible, like I’m not, your arms will go numb. You can ask for foam to be placed under different parts of your arms to help with comfort. You will be lying like this for about 25-30 minutes. They also provide earplugs and earphones, some places will provide music if you want. MRI’s make LOTS of loud noise, rhythmic banging and knocking, not so bad that you have to wear the earplugs and headphones, but pretty darn loud. When it’s not making noise they are readjusting the set up to take the next scan, and this is when you can wriggle fingers etc to keep somewhat comfortable.
There is also a microphone so if you are uncomfortable you can let the operators know at any time.
25-30 minutes later it’s all done, you’ll come out of the machine, have the cannula removed, get dressed and head home. The results will be provided by Radiologist either directly to you or to your GP.
As mentioned, my initial MRI diagnosis was an approximately 10mm mass that the Radiologist believed was a Fibroadenoma. This mass did not show on either the Mammogram or Ultrasound I had already had. To be conclusive, an ultra-sound guided Biopsy was recommended. It’s kind of like saying ‘may contain traces of nuts’, they have to cover themselves but it is ultimately your decision as to whether you choose to go forward with the biopsy or not. Because I had had so much discomfort/aching around my right breast several times over the previous 9 months or so, I decided on the biopsy.
And that is how my cancer was found.
That MRI allowed the lump to be detected early (it ended up being around 5mm but after the biopsy, surgery only had 2.5 x 2mm left to remove).
I am so grateful to Jeremy Price for his honest and open discussion with me around breast density and how an MRI is the best way to see early masses in breasts. I am also so grateful that I am in a position to be able to afford the cost of full payment for that MRI.
We need to work on the Government to get MRIs for women with formally graded dense breast tissue to have some subsidy for the costs of the MRI.
Listen to your body, and do whatever you need to do to be comfortable that everything is OK.
31.12.13 / Breast Density / Author: admin / Comments: (0)
In the USA, a law was passed in 2009 in Connecticut related to notifying women of their breast density based on their mammograms. Physicians are required to send a letter. Other USA states have also passed similar legislation.
This is a tricky area, as density is only one factor that should be taken into account by women in regards to any decisions made.
Further Information: http://breastscreeningaustralia.com/2013/08/15/national-breast-density-notification-amendment-advances/
31.12.13 / Breast Density / Author: admin / Comments: (0)
So you now know, from your Doctor, that you have dense breasts. Hopefully, they have given you an indication based on the BI-RADS system.
Grade 1 and 2 have a small elevated risk.
Grade 3 and 4 have a higher elevated risk. This does not mean you have to panic!! What is DOES mean is that you need to be especially vigilant. You really have to know your body, and more importantly, LISTEN to your body.
You need to talk with your doctor about other factors such as age, weight, pre or post menopause, hormonal treatment, diet, family history and genetics. And THEN you have to add in your breast density. Density should not be the only driver in your decisions. Speak with your Doctor and/or a specialist Radiologist.
If you are over 40 and are not already having regular mammograms, start having them now. In Australia, BreastScreen provides these free every 2 years once you are over 40. Mammograms are not embarrassing (the radiographers sees hundreds of boobs each week), and they are uncomfortable for seconds only. Surely this is a small ‘price’ to pay for some peace of mind.
If you decide you want to be more vigilant, perhaps include Ultrasounds. And, if you want to go further, perhaps an MRI every 2 years. MRI plus Mammogram is a good combination, perhaps alternating each year.
This is a very personal choice, and is also dependent on your monetary situation. MRI’s are not cheap and are not covered by Medicare in Australia.
Now, I know and understand that some women don’t get checked because they don’t want to have the potential for a negative outcome. They don’t want to find a lump. This is a tough one. No-one wants to find a lump or abnormality. EARLY DETECTION IS KEY TO A POSITIVE PROGNOSIS. The statistics show that the earlier and smaller the cancer, the better the long term prognosis. It can often mean a much shorter and less intrusive treatment cycle as well.
31.12.13 / Breast Density / Author: admin / Comments: (1)
The American College of Radiology (ACR) developed a standard way of describing findings from a mammogram. It is called the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS includes a category for reporting breast density.
BI-RADS 1: Less than 25% of the breast is fibrous and glandular tissue
BI-RADS 2: 25% – 50% of the breast is fibrous and glandular tissue
BI-RADS 3: 51% – 75% of the breast is fibrous and glandular tissue (this means it is now becoming more difficult to see small masses such as cysts or tumours)
BI-RADS 4: More than 75% of the breast is fibrous and glandular tissue. This is where some cancers can be missed
BI-RADS is not routinely recorded in Australia, except in Western Australia.
How this grading looks in pictures
31.12.13 / Breast Density / Author: admin / Comments: (1)
So, you’ve been told your dense …. Well, at least your Breasts are dense! What does that actually mean?
Breast Density looks at the different tissue within your breast, and what it is made up of. It can be made up of fatty (non-dense) tissue and connective (dense) tissue. Dense tissue can be: fibrous or glandular tissue.
Your breast density can be measured with a mammogram. The breast tissue will show up much more white than less dense tissue, which will show as grey and transparent. You might feel quite thick and lumpy all the time, and for women, not just when menstrual.
Breast Density decreases with age and after menopause due to hormonal changes. But it is different across women of the same age. It is also higher in pregnancy and lactation. Hormonal therapy can also increase breast density.
It is recognised that increased breast density means there is also an increased risk of breast cancer, while leading to a lower accuracy or ‘sensitivity’ of mammographic screening for cancer detection. But this is a controversial area.
The main issue in Australia is that women who have dense breasts on a mammogram are not currently monitored any differently from other women. Even though there is mounting evidence to suggest that breast density is linked to a greater lifetime risk of breast cancer, more aggressive tumours and a 50% change of screening missing tumours.
Further information here: http://www.breastscreen.health.wa.gov.au/docs/BSWA_BreastDensityInformationSheet_March2013.pdf
31.12.13 / Breast Density, Uncategorized / Author: admin / Comments: (2)
My Mum passed away in 2001 from secondary breast cancer in the Liver. It had metastasised. It was 3 weeks before her 61st birthday.
From then on I had annual checks on my Breasts.
I had always been told I was ‘lumpy’ and had dense breast tissue. Every now and then there was a lump that was investigated through an FNA (Fine Needle Aspiration). But everything was clear.
This year (2013) I went to the Dr for my usual ‘girl’ checkups, including a breast check. I mentioned that I’d been particularly sore on the right side and that it seemed to last a lot longer than the usual menstrual cycle issues. She agreed I was very lumpy, and suggested I see a new Radiologist who specialises in Breasts. The downside was that it was a private practice and I would end up paying more. He might even suggest an MRI (Magnetic Resonance Imaging) scan.
But off I went. I had the usual Ultrasound and Mammogram and everything was clear. I also had a consultation with the Radiologist, Jeremy Price, in regards to Genetic Testing. As my mum was the only family member we know of that has had Breast Cancer, my risk was very low, so we decided not to do the genetic side of things. I also later found out that the tests are quite expensive.
However, further discussion around Breast Density decided me on having an MRI, just to be sure.
Jeremy found a lump in my right breast but thought it was a Fibroaedenoma. A biopsy would confirm if this was the correct diagnosis. It was a slippery little sucker to find! The radiographer couldn’t find it with ultrasound so went out to get Jeremy. In the meantime, I rolled onto my left side and located it right around near my armpit of my right breast. Lying on your side is not a position that we are suggested to use during self checks! But this appeared to be the only way to locate it.
Even after I located it, finding and keeping it in the viewer proved challenging – but the biopsy was finally done.
Four days later, my Dr rang with the news that the biopsy showed an Invasive Ductal Carcinoma (IDC) and my Breast Cancer Journey began.
The lump was approximately 5mm (very small) at the time of the biopsy.
Nearly 3 weeks to the day of my diagnoses, I was in surgery for my lumpectomy. Five lymph nodes were also removed. These are checked while you are under anaesthetic using a quick test by a pathologist who is in the Theatre at the time of your surgery. This is so they can decide if they need to do a full auxiliary clearance while in surgery (i.e. remove all the lymph nodes) if cancer has been detected. No cancer was detected in my quick tests. However, the lump and nodes are still sent off for full pathology. And you get to wait 10-14 days for the results. This can be hard, but I kept positive and busy until the results.
In the meantime, I read and read and read (see ‘Taking Control’). By the time I got my results at the next surgeon’s consultation, I had a good understanding of what they, and the report, were saying. I also made sure I was given a copy of the report for my files. Keep copies of EVERYTHING.
The lump was 2.5x2mm (some had been removed during the initial biopsy), margins were clear, all 5 nodes were clear. I was HER2 negative (this is good) and the cancer was Oestrogen and Progesterone positive (also good as this can be treated with hormone receptive drugs).
Bottom line: we got it all, you won’t need chemotheraphy, you will have a 6 week course of Radiation Therapy, then go onto Tamoxifen for 5 years or until menopause.
BREATHE.
