Being Proactive about Breast Screening After Breast Cancer

In the near year, I am proud of a resolution I added to my health checklist after an annual screening mammogram. As a survivor of breast cancer who remains at high risk for breast cancer in her remaining breast, I decided to be more proactive about screening. Even as we trust our medical providers to advocate for us, we must also learn to speak up for ourselves.

You would think I would be overzealous, having gone through intense treatment for invasive breast cancer. I would prefer not to go through that again. Whereas HER2 cancer was not related so much to my general high risk based on family history and dense breast tissue, I liked to imagine that the treatments for that first cancer nipped any future cancer in the bud. That is what we call magical thinking. Even if cancerous tumors are eradicated, new cells can find their way into our bodies.

After cancer treatment, the guidance was for me to get an annual MRI because even the mammogram that identified a problem had missed the full extent of the cancer. It had taken neither imaging nor a biopsy but a full mastectomy to show the extent of invasiveness. After getting the MRI for some years, I was advised that the new 3D mammogram was much better than what I had received previously, so I switched to that, with the idea that I would get an MRI every five years for good measure to get a thorough check of the dense breast tissue that can mask cancer.

This year should have been an MRI year, but I stuck with the 3D mammogram, assured it is a good tool for detecting early breast cancer. If only they had been in widespread use in 2010. Ideally, we get diagnosed while the cancer is in situ or very early, which a 3D mammogram is more likely to find. In fact, sites such as breastcancer.org remind us that 3-D mammograms “find more cancers in people with dense breast tissue.” This is why I felt comfortable switching from the MRI.

Another reason I felt comfortable shifting to the 3D mammogram was a recent ruling by the U.S. Food and Drug Administration (FDA) on follow-up for dense breast tissues, with mammogram reports required to note how dense breast tissue can mask tumors, with follow-up scanning advised as warranted. Ultrasounds suggested for those at average risk and the MRI for those at high risk. Where do I fall? I know I am higher risk, but I also like to think (magically) that I am at average risk.

I looked at my mammogram report for clues. It said, essentially, that no issues had been found, but with my dense breast tissue tumors could be concealed within my breast. That word “tumor” caught my eye. I requested a follow-up ultrasound, knowing I would need more discussion with a provider to get back on the MRI path. The ultrasound pointed out a few more things within the tissue but detected no evidence of probable tumors. For the first time in a few years, I breathed a sigh of relief, trusting my annual breast screening to have looked deeply into my breast tissue.

Haunted by an invasive cancer diagnosis that was not found via a mammogram, or even an initial biopsy which indicated simply “in situ,” I have let my past experience affect my attitude towards routine screening mammograms. I let my reliance on the 3D mammogram trick me into thinking that all would be well, that any cancer would be found earlier than it was the first time around with a traditional mammogram. This is not necessarily so.

Consequently, in the new year I will work with my provider to sort out my unique needs. We might all think about doing that. When a mammogram report is a rubber stamp, find ways to tailor medical protocols to fit a high-risk survivor’s needs.

This piece reflects the author’s personal experience and perspective. For medical advice, please consult your health care provider.

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