Mammograms: Up to 40% of Women May Have Dense Tissue, Poor Diagnostics

Posted on April 3, 2012


The phone call came at work.  There was “an issue”  with my mammography images, and the radiology clinic wanted me to come back for re-imaging.  “What issues?” I asked.  “We can’t tell you, you have to talk to the doctor.”  “Okay, have him call me.”  There was resistance.  They couldn’t or wouldn’t have the doctor call.  I just had to come back.  The first available appointment was two weeks away.

I wasn’t too worried.  This was my “baseline” mammogram.  It had been painful; I am small and my tissue just did not compress well.  I felt bruised and sore for nearly a week afterward.  And now they wanted me to do it again?

I had long been a bit suspicious of the whole mammogram requirement.  There had been controversy about its efficiency in saving lives, about risks, about costs.  Yet it was pressed upon women almost as an absolute requirement.  Every year that I refused the exam, I got all the arguments as to why I really should do it.  In the end, I would leave the doctor’s office followed by chastising looks as if my refusal were somehow shameful.

So, with my 40s well underway, I finally submitted to a baseline, intending to do nothing more until my 50s (at least!).  Now, here I was back at the clinic for the second time in a month.  I asked to see the radiologist before having any more imaging done.  I was not about to submit to anything more until I knew exactly what these “issues” were.

The radiologist put my films up on the light box.  They did not look like other women’s films.  They were almost completely black… except for small crescents of solid white at the very edge of the films.  Those were my breasts.  Well, I knew I was small… amend that to very small.  But it wasn’t the size that was an issue, it was the density.  The films were diagnostically useless.  The radiologist explained that they needed to repeat the mammogram with a higher level of radiation to get a better image.  With misgivings – this would make a total of nine films in one month, and five of them at a higher radiation dose –  I consented, in the hopes of getting some kind of useable baseline.

The radiologist showed me the new images and brightly said, “Oh, this is much better!  You see?  I can identify some structure here.”  I am not a doctor and certainly can’t read an X-ray, but these images looked… well… only slightly less white than the previous ones.  “If there were a cyst or a tumor in there,” I asked, “could you see it?”  She paused and looked down.  “Well, no.  But… it’s still important.”   I disagreed.  If it’s supposed to detect cancer, but my films can’t do that, then it is all risk and cost with zero diagnostic value.  “I am never doing this again,” I told the radiologist.  And there was that chastising, shaming look again.

Ever since that experience, I thought my case was unusual.  It is not!  Up to 40% of pre-menopausal women have breast tissue like mine, dense enough to interfere with reading their mammograms.  And no one has been telling them so.   So they get their mammograms, year after year, and in some unlucky few, malignancies go undetected.

This is why several states either already have, or are contemplating, requirements for doctors to tell their patients if they have dense breast tissue.  Alternative screening methods such as ultrasound can catch anomalies that X-rays will miss; in Connecticut, cancer detection in women with dense tissue went up 100% after their requirements went into effect.  California is the latest state to weigh this requirement in their legislature.  Connecticut, Virginia, and Texas already have such laws in effect.  As California State Senator Joe Simitian says, “Women have the right to know about the risk factors they face and the limits of mammography.”