I’d planned on getting my first one at 45 or even 50 because of having no breast cancer in the family and no major risk factors- those were the recommendations I recalled from my younger days. Mammograms in younger women aren’t as reliable in finding problems because younger women have denser breasts. The mammogram is an x-Ray and those x-rays have trouble seeing through all of that density. As one ages, the fibrous density in the breast gets replaced by fat and fat is much easier to see through with an x-Ray. This is why mammograms in pre-menopausal women can be challenging. 

The average age at diagnosis for breast cancer is 62. I got mine 20 years early. In women younger than 50 at diagnosis, the cancers are usually larger, more aggressive, and are more likely to have already spread. Some of this is due to younger women often having genetic abnormalities pre-disposing them to cancer. Younger women are more likely to have kinds of breast cancer that are more aggressive (HER2 positive or triple negative). Or, the mammogram has trouble seeing through dense breast tissue. Or, they aren’t even getting screened. That would have been me if it weren’t for my first cousin-in-law. 

I’d only met her once shortly after I got married because she lives far away, but she and I are Facebook friends. When she turned 50, she had a breast cancer diagnosis, shared it with everyone and even had a Facebook group giving constant updates about her surgery, radiation, and reconstruction. Hers was found as part of a routine mammogram. I was 40 at the time and commented on having not planned to get mammograms until 50. She encouraged me to change my mind and I did.

It is surprisingly quick and easy to get a screening mammogram appointment. I went in one morning having no antiperspirant or lotion on that might interfere with the scan, took my top off for a few minutes and had two images taken of each breast. It was quick, easy, pleasant, and low cost. Yes, the breasts are compressed for a few moments but unless one has particularly sensitive breasts, it is a moment of discomfort. 

I was sure it was going to be fine. I was young, healthy, a normal weight, and no concerns. I didn’t expect the phone call the next day wanting more scans. 

My baseline mammogram showed some unevenness or asymmetry when comparing one side to the other side. Specifically, they wanted diagnostic mammogram images of my right side. It concerned me a little, but I went in and it was just like the first time except only on the right side. Two pictures from two angles and a brief wait as the radiologist in the other room I never saw wanted two more before passing on the information that everything was fine. I went home feeling good. My breasts were dense, type C. 

I went back in a year for another screening. This was the year 2020 and the pandemic, but I continued with my screenings since they weren’t being postponed like non-essential procedures had been earlier in the spring. This time, no additional views were needed. Still was density type C. 

I didn’t make it to my third annual mammogram which would have been scheduled for next month. Nine months after a clear 2020 mammogram, I found a lump, had been diagnosed with cancer, had surgery, and was in treatment. This is called an “interval cancer” and it is bad news. Cancer found in the interval between regular screening tends to be aggressive. It is a much better prognosis to have your cancer identified after a routine screening. 

Because I haven’t really been telling people that I have cancer - that’s for another post - no one asks me if I think my clear 2020 mammogram missed a tumor. There are two answers to that question. The first is that my cancer is grade 2, on a scale of slow to intermediate to fast growing, so it probably was there in 2020. I might have had this growing for a year or two. However, the second point is that mammograms can only see abnormalities once they get to a particular size, which is around 1cm. If it was there in 2020, it was too small and probably obscured in breast tissue densities. 

For lumps to be felt by hand, they also need to be a particular size. For people who do regular self exams and know what their breast feel like, being sensitive to changes, a lump might be felt at around 1.5-2.5cm. But for those who accidentally find a lump on their own, those lumps generally are much larger at 4cm. The larger they are, the more likely they are to have spread. Not all breast cancer manifests in lumps. It might be nipple discharge. It might be puckered or dimpled skin like an orange peel. It might be red and inflamed skin or a flaky areola. 

Mine was a lump. 

Even though mine was found by accident (not even a self exam) and not through a screening mammogram, I had more confidence in knowing that I probably caught it early.

After referral, I was getting a diagnostic mammogram of my left breast on July 10 followed by an ultrasound. I went alone because I still thought of it as pretty routine and wasn’t really concerned. 

The ultrasound was more uncomfortable in that the operator pressed the transducer into you for a lot longer and even into your arm pits. I could see what the operator was seeing on the screen. There was something blobby and black and I couldn’t remember if black meant fluid-filled or solid. 

After I got dressed, the radiologist came in to discuss the findings in that it looked concerning and that it was important to get a biopsy as soon as possible. The nurse was asked to immediately contact my primary care provider to get orders for a biopsy. I wasn’t overly concerned yet because I know that the ultrasound ruled out a cyst, but that most biopsies are often benign anyway (something like 85%). It would just be an uncomfortable procedure -it was explained to me how it would go and how to prepare- and a little waiting.

When I got home and looked at the online patient portal, the results had been posted quickly and I read the words BI-RADS 5 and knew that it was more serious than I thought. 

BI-RADS is a radiology classification system ranging from 0-6. BI-RADS 5 means an over 95% chance of malignancy. Even a negative biopsy in the case of BI-RADS 5 wouldn’t be trusted. A 1.1cm solid mass at the 2 o’clock position and located 9cm from the nipple far over to the side. 

I knew I had cancer and that I was really just waiting for confirmation at this point. That was when I felt anxiety about getting a diagnosis as quickly as possible so I knew what we were working with and could have a plan. 

The next step was the biopsy and scheduling the biopsy was the most stressful part of the whole cancer process (so far).