The Mammogram Results (Ep. 4)
Join me in this series of breast cancer awareness as I document my DCIS (Stage 0) diagnosis at 40 years old. My goal in this series is to share my experience to help inform others about the knowledge, prevention and treatment of breast cancer.
So, you’ve gotten a mammogram! Bravo!
Here I’ll share my experience in my follow-up appointment after my first mammogram.
In my previous blog entry, "The Mammogram," I shared my experience with my first mammogram shortly after turning 40. I can’t stress enough how important it is for women to fight for access to mammograms. Early detection is the best chance we have to fight against breast cancer.
I’ll mention again that only about 10-13% of mammograms lead to further tests, and of those, just around 0.5% are diagnosed with cancer?
Source: https://www.komen.org/breast-cancer/screening/mammography/getting-a-mammogram/
While it might be scary to think you can be in the 10-13% group, it really is better to find out earlier than later.
Please know that the 5-year survival rate for Stage 0-1 breast cancer (early-stage) is 99%! Don’t wait to get screened, the earlier the better.
So, let’s chat about the results of my first mammogram. When my follow-up appointment arrived I really expected everything to be completely fine. It was my first mammogram, it was scheduled as preventative, I really never thought there would be an issue. I was honestly shocked to my core when the doctor explained that the results had come back abnormal.
The appointment went as followed: he explained to me that I would need additional testing and asked questions about my family history of female cancers as well as whether I had undergone BRCA testing (which checks for genetic markers indicating a predisposition to female cancers). I hadn't, but I'll be covering that in a future entry. The doctor also emphasized the importance of making sure I exercised regularly, recommending intense cardio at least three times a week. Easier said than done, right? But, he noted that staying active could significantly reduce the risk of certain cancers. (More on this later, as well!)
Our appointment wrapped up with prescriptions for further tests: an ultrasound, an MRI, and a stereotactic biopsy.
Initially, I didn’t ask many questions – I was processing it all. However, after some time, I started wondering about the specifics of my results and what these next steps entailed.
So, what did my mammogram actually show?
In simple terms, a cluster of irregularly shaped microcalcifications, a BiRads score of 4B, and a density category of C. But what does all this mean? Let’s break it down.
Breast Calcifications
Dr. Mark Dryden from the University of Texas MD Anderson Center explains that breast calcifications are small calcium deposits found in breast tissue, often too tiny to feel. They can be macro (larger) or micro (smaller), with microcalcifications sometimes indicating early breast cancer. However, most are benign and more common as we age, especially if a woman has breastfed.
Science isn't completely clear regarding the cause of breast calcifications, but it is known that a calcium-rich diet is not correlated.
Source: https://www.breastcancer.org/screening-testing/mammograms/calcifications
My report mentioned a grouping of pleomorphic microcalcifications. These small calcifications, I was told, were like tiny pieces of rice. The word “pleomorphic” was the cause for concern. This meant they had “morphed” and were different shapes and sizes.
BiRads Scale
This scale, developed by the American College of Radiology, helps radiologists describe mammogram findings. It doesn't diagnose cancer but indicates if something looks suspicious. A score from 0-2 is usually associated with normal or noncancerous results. If the score is 3 or above, radiologists will usually recommend further investigations.
The BiRADS range is the following:
0: Unclear Findings or Incomplete testing
Meaning the mammogram was difficult to interpret or another issue. This will require additional testing to provide a conclusive report.
1: Negative Mammogram Results
There is no indication of cancer. The breast tissue appears normal, with no masses, calcifications or abnormalities. Both breasts appear with equal density. The recommendation is continued monitoring with mammograms.
2: Benign Mammogram Results
There is no indication of cancer, but the radiologist may find some benign finding, such as a mass, calcification or abnormality, that warrants regular mammograms. This finding will be used for future comparison.
3: "Probably Benign" Mammogram Results
The finding of a mass, calcification or other abnormality is probably benign, with a less than 2% chance of cancerous findings. The radiologist might suggest a 6-month follow-up to track any abnormalities.
4: Suspicious Mammogram Results
There has been a suspicious or abnormal finding. A biopsy, which is a small sample of the abnormal tissue, is recommended for further information. This category is split into three categories:
4A - Low suspicion for cancer or malignant findings (2-10%)
4B - Moderate suspicion for cancer or malignant findings (10-50%)
4C - High suspicion for cancer or malignant findings (50-95%)
5: Highly Suspicious Mammogram Results
There has been a highly suspicious finding. There is at least a 95% chance of breast cancer. A biopsy is highly recommended for further information.
6: Previously Diagnosed Mammogram Results
This category is only for those who have received a previous breast cancer diagnosis. This mammogram is used for comparative purposes during treatments such as chemotherapy, surgery or radiation to track treatment responses.
Source: https://www.healthline.com/health/mammography
My mammogram was graded a 4B, which from the scale above shows moderate suspicion for cancer or malignant findings. This honestly was the sucker punch when I received the report. My best advice is to not stress when these findings come back. Until further testing is done, there is really no way to know anything for certain, and the stress in the meantime will only make you feel worse. I really advocate stress-relieving activities and finding an outlet. I also find this quote can be helpful in times of unceratinty:
“Worry never robs tomorrow of its sorry, it only saps today of its joy.” - Leo Buscaglia
Breast Density
Breast density is a measurement of how much dense tissue versus fatty tissue is in the breast. It matters because dense tissue can make it harder to spot cancer on mammograms and may slightly increase cancer risk. The only way to know your Breast Density is for them to be graded by a radiologist from a mammogram. You can not feel how dense your breast tissue is.
There are four categories of breast density, which are:
A: Almost entirely fatty
These breasts are composed almost entirely of fat. About 1 in 10 breasts are categorized here.
B: Scattered areas of fibroglandular density
These breasts have some density, but the majority of the tissue is "non-dense." About 4 in 10 breasts are categorized here.
C: Heterogeneously dense
These breasts have some "non-dense" ares, but the majority of the breast is "dense" tissue. About 4 in 10 breasts are categorized here.
D: Extremely dense
These breasts are nearly all "dense" tissue. About 1 in 10 breasts are categorized here.
My breast density came back as C, which is a quite common grading. Breast density is important in understanding you own risk factors for breast cancer.
Why would I have dense breasts?
Here's what science believes:
You are younger. For some, breast density changes with age, with the breast becoming less dense over time. However, some breasts may remain dense always.
You have a lower body mass index (BMI). Bodies with less body fat show to have denser breast tissue compared to bodies with a higher BMI or obesity.
You are on hormone therapy. Some hormone therapies, such as those to relieve menopausal symptoms, may cause denser breasts.
Source: https://www.mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968
There are other findings from the radiologist that may come back in your report that I haven't included here. As always, it's best to discuss all reports and findings directly with your own medical professional.
In my next blog, "The Ultrasound and MRI," I'll share the next chapter of this journey. As always, I'm not a medical professional, just someone navigating this path and sharing my story. Your health decisions should always be guided by your healthcare provider.
As always, thanks for being here!
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Take care and continue creating,
