Your annual mammogram may miss breast cancer hiding in dense tissue

Health

OKLAHOMA CITY (KFOR) – October is Breast Cancer Awareness Month, and we want to shed some light on screening tools for women.

Breast cancer screening can be controversial. Not all experts agree.

However, more and more doctors believe a simple mammogram may not be enough to find many breast cancers.

Annual screening mammogram has long been considered the best first line of defense.

But, for some women, breast cancer can hide inside dense breast tissue where even a mammogram cannot see it.

Kristye Kirk-Shores started screening mammograms early in her twenties.

Year after year, her mammogram reports came back negative.

But because of a family history of other types of cancer, Kirk-Shores opted for a more specialized breast screening in her 40s.

Kirk-Shores believes she is alive today because of a screening MRI ordered by her doctor.

At 50 years old, the mammogram missed her cancer.

It was found on a screening MRI.

Breast MRI identified a 2.8 cm, Stage 2, Grade 3 breast tumor.

“At the time of my diagnosis I wasn’t having any symptoms. I had no lumps,” said Kirk-Shores. “I was stunned and scared.”

Half of women have dense breast tissue, and for those women, mammogram may not be enough.

“If you have dense breast tissue, the odds of the cancer being missed on mammography start going up dramatically,” said breast cancer researcher Dr. Alan Hollingsworth. “By the time you get to level D density, there’s only a 30 to 40 percent detection rate.”

A radiologist determines breast density level at the time of mammogram.

Ten percent of women have Level A density; the breast is almost entirely fatty tissue.

Forty percent of women have Level B density; scattered areas of density.

Another 40 percent of women have Level C density; the majority of breast tissue is dense.

Ten percent of the population have Level D density; extremely dense, almost all of the breast tissue is highly dense.

Many women don’t realize they can can walk out of an appointment with a clean mammogram report and still have undetected cancer.

“It would be nice to be able to select which patients need a screening MRI, with a blood test,” said Dr. Hollingsworth.

Dr. Hollingsworth is an Oklahoma City surgeon and published breast cancer researcher.

He is one of the first to focus on cancers missed by mammogram.

He hopes his work will someday contribute to a blood test to determine who needs more than a mammogram.

Breast MRI has long been a go-to for cancer detection.

But it’s expensive, uncomfortable and often not-covered by insurance for cancer screening.

“I see that (MRI) machine find cancers earlier and more reliably than mammography. It would be very rare to have an advanced cancer if you’re having MRIs,” Dr. Hollingsworth said. “It’s very precise. We don’t need any more technology breakthroughs. We need to know, who to put on that machine.”

Hollingsworth has spent 30 years developing a protocol for which patients need more than a mammogram.

“We’ve brow-beat the American public into thinking mammograms are it,” he said.

Today, mammograms are part of the solution.

Breast ultrasound is even more precise.

Breast MRI is proven to detect the smallest cancers at the earliest stage.

“I would just urge women to get those MRIs and to get those mammograms; to be assertive and find a great doctor because a slight inconvenience today can give you more and brighter tomorrows,” said Kirk-Shores. “And it’s a great feeling to know you’re doing all you can to fight cancer.”

The first step is knowing your breast density.

In Oklahoma, your density level will be listed at the bottom of your mammogram report.

If you are Level C or D, you should consider asking for a breast ultrasound or screening MRI. 

In 2016, the Oklahoma Legislature passed a state law requiring women to be notified and counseled about their breast density as part of their mammogram report.

If you have questions about your density or your screening options, talk to your doctor.

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