Breast Backwards: From One Size Fits All To Personalized Breast Cancer Screening After My Advanced Stage Breast Cancer Diagnosis

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There are multiple occasions when I discover just the perfect top only to be disappointed that its one size fits all did not fit ME. This is exactly what I stumbled on when I ended up with an advanced stage 3C breast cancer within weeks of my 11th NORMAL mammogram. For nearly a dozen years, this average risk woman NEVER missed her mammogram appointment. I had no first degree relatives with breast cancer, exercised daily and ate healthy. The purpose of my dutiful screening regimen was for protection from a late stage cancer, in the unlikely event that I was diagnosed with the disease. When my annual mammography exam was due, it was always at an inconvenient time. All of my health care providers were located near my residence, an hour away from my employment. Most of the time my mammogram was the last scheduled one of the day. Often I would find myself at a meeting which exceeded its scheduled ending time and, after excusing myself, would hightail over hill and dale to the mammogram appointment -- because of my fervent belief in its promise of early detection.

The reaction to my starling diagnosis, with metastases to 13 lymph nodes, was not that I was diagnosed with breast cancer; it was that it was at an advanced stage, within weeks of my 11th 'gold' standard mammogram. It was also astonishing that at the time of my late stage diagnosis, after practically arm wrestling my team of docs as to what happened to my early diagnosis, it was finally revealed to me that my dense breast tissue masked my cancer on mammography for years. Even though this critical breast health information was known by the medical community and in scientific journals for more than a decade before my diagnosis, not one of my health care providers thought it might be important to my health and my life to know about this potentially fatal flaw caused by the limitations of mammography. The promise of early detection for me and innumerable women with dense breast tissue is a beautifully created fairy tale with a potentially 'unhappily ever after' ending as the size of the breast cancer and how far it has spread, even in light of new treatments, remains vital to surviving the disease.

When I discovered that my right breast contained a cancer three times the size that it should have been if my screening mammography did what it was promised to do, I questioned my team of docs as to their confidence that there wasn't another intruder hidden in my left breast. That information would be critical as I decided my surgery choice. An MRI was ordered and within several weeks I was wheeled off to the operating room facing an 8 hour right breast latissimus dorci flap mastectomy with reconstruction.

Since I still retain a 'good' breast, I continue to be a consumer of breast screening. From the time of my advanced diagnosis, until today, my health care team is keenly attentive about my screening regimen, discussing my personalized risks, including my 'dense' left breast, taking into account my personal screening preferences -- annual ultrasound screening six months after my annual mammography and biennial MRI. Why did it have to take a missed, delayed and advanced stage breast cancer diagnosis for me to have access to personalized screening to give me the benefit of an early diagnosis? An ultrasound with a skilled radiologist would have discovered my cancer well before it had metastasized to 13 lymph nodes. Without a doubt, my life-long side effects from my aggressive treatments would be diminished, including better life outcomes for surviving this disease, as ER+ breast cancer can recur for more than two decades after diagnosis.

The randomized controlled trials of mammography conclude that the magnitude of the reduction of advanced stage breast cancer is associated with the magnitude of the reduction of mortality. While the diagnosis of early breast cancer has increased over many years, the corresponding reduction of advanced disease has not achieved the same increase. Discussing the issue of dense breast tissue and screening, Tabar et al state, "Going forward breast cancer screening programs should embrace the opportunity to tailor imaging to provide the greatest benefit to all women to reduce advanced disease for mortality reduction to be achieved."

A breast health screening regimen that fails to take into account a woman's breast tissue density and her preferences will continue to miss the advanced killing cancers as one size breast cancer screening fits none.