Moving Beyond Density: A Black Woman’s Breast Cancer Journey
We have been bosom buddies for as long as I can remember – going back to when I was 10 years old. Across the decades, these two have been close to my heart and held most of what is dear to me. I could always count on them to make me look good, feel good and even be a source of life for my children.
Now, as a prepare to lose my right breast, I realize what I have taken for granted and a flood of thoughts and emotions course through my mind and my body. I ping pong between total peace and outright panic. Of course, I need this surgery to remove cancer from my body — to live—but how will this change my life, my body, the most intimate parts of my marriage? I have so many questions as I try to process this diagnosis and the impending collateral damage, but the most persistent question is:
How did I get here? How has two and ½ centimeters of cancer been allowed to grow in my body when I get mammograms like clockwork –every May as the flowers in my pots begin to bloom. An ultrasound usually follows my mammogram scans just to be sure there are no changes my breasts, which could flag a potential cancer. After my mother died of breast cancer at age 57 (my age at diagnosis), I became hypervigilant with my self exams and annual mammograms.
Every year, I would skip out of the doctor’s office after the nurse practitioner (who does a manual exam after the scan) declares “you’re good to go! See you next year.” Meanwhile, this cancer has been silently growing inside me, an insidious deadly mold burrowing into my right breast.
When I pose the how-did-I-get-here question to my doctor, whom I adore and have been seeing for 10 years, she nods with compassion and states the obvious. “We don’t know, sometimes it happens.” But then she pauses and mumbles: “You do have dense breasts and sometimes it’s hard to see.”
After mulling this over a few days, the light bulb began to glow in my brain, now fogged by 12 weeks of chemotherapy. All the dots connected in my chaotic mind to reveal a horrifying picture of millions of unsuspecting women dying while the medical community looks on seemingly helpless.
Dense breasts. Black women have dense breasts.
The National Breast Cancer Foundation estimates nearly 50 percent of all women over 40 have dense breasts, defined by considerable amounts of glandular and fibrous connective tissue seen on mammograms.
Yes, 50 percent of all women over 40 have dense breasts, and the American Association for Cancer Research tells us the incidence of dense breasts is even higher among Black/African American women.
So, is it a coincidence that Black women die at a 40 percent higher rate than white women from breast cancer? How do we explain that breast cancer is the second most common cancer in women after skin cancer and the leading cause of cancer death in Black and Hispanic women?
To be fair, my doctor told me about five years ago that I had “heterogeneously dense breasts.” For that reason, she wanted me to do ultrasounds each year, in addition to mammograms. This was 2018, the year before the state began requiring physicians to let patients know their breast density rating.
I was scored at a C, the second highest rating for density, meaning the radiologist trying to read my mammogram must have felt like he was looking for a snowflake in a snowstorm.
That’s because dense breast tissue shows up as white on a mammogram. Cancer also shows up as white. The denser your breast tissue, the harder it is to see that cancer. Sometimes there is just an odd shape or pattern that was not on the previous scan.
I am sure that is what happened to me. In September 2022, my breast surgeon called to say my mammogram “showed a distortion” so I needed to return. No big deal, this was routine for me by now.
But a couple of days after the ultrasound, she called back to say I needed an MRI because the ultrasound did not show anything, but she was certain there was an abnormality.
Three days later, there on the MRI scan was nine centimeters of a what I will call a mystery mass needed to be investigated. A thorough investigation, including two painful biopsies, revealed 2 ½ centimeters of invasive cancer in my right breast. The breast had to be removed.
All I could think of was my mother facing the same fate some 20 years earlier. Looking back, I was blessed to have had the as opportunity to witness at least part of her journey. At the time, I was living out of state and could only travel to Chicago, where she lived, for her surgery. I wasn’t there for her treatments. Still, that limited time I spent with her was powerful. I can still hear her groggy voice reassuring me, “Zion, it’s supposed to happen this way.” She had me open the bible to Psalms 23 and read it as she drifted off to sleep. My mom died a week later on May 17, 2002.
Relying on my mother’s faith, I felt equipped to go into battle with the same disease that took her at age 57.
The sadness I felt for my mom gave way to outrage for myself – and my friends’ whose dense breasts also hid their cancer. Crashing through the dense fog in my brain like a mad bull, I am now concerned about all the women who have no clue what it means to have dense breasts and, as a result, blow off their doctor’s cursory status update, “Oh, you have dense breasts,’’ spoken as casually as, “You must be a C-cup.”
Do they know what it means to have dense breasts? What the life-and-death implications are?
What is more outrageous to me is how the medical team looks at me when I am telling them about the connection between dense breasts and cancer and they say – softly – “we know.”
One doctor even told me the ultrasound which they routinely call patients back for only shows a mass. So, if your breast cancer presents as calcification —which mine initially did -- the ultrasound will not pick it up. It was only after I entered the cold cave of the MRI machine that the true extent of the suspicious — nine centimeters—was revealed.
So that raises another question: Why do doctors not recommend MRI testing for women with dense breasts? Maybe the insurance industry will have to answer that one.
Alas, all is not lost. Along my journey, I have discovered a few bright spots.
The FDA recently mandated patients be informed of their breast density status following mammograms. The hope is that the information will help determine if further testing is needed beyond mammograms.
National Cancer Institute suggests patients with dense breasts ask their physicians these questions:
What are the dense breast-related findings in my recent mammogram?
Do you recommend additional screening or diagnostic tests for me?
What is my overall personal risk of breast cancer, given my risk factors and protective factors?
A Chicago-based doctor is leading the large study to determine what testing strategies are best for breast cancer screening. A brilliant breast cancer oncologist and researcher Dr. Funmi Olopade co-leads the Wisdom (Women Informed to Screen Depending on Measures of Risk) study. Visit wisdom.org to learn more.
My darling husband of 33 years always says don’t ask questions you don’t already have the answer to; I lovingly and respectfully disagree. Questions surrounding breast cancer in Black women loom large, and we would like answers.
Sources:
https://www.cancer.gov/types/breast/breast-changes/dense-breasts
https://www.cancer.org/latest-news/breast-cancer-death-rates-are-highest-for-black-women-again.html