The global breast density conversation: Meet one woman driving change in the United Kingdom

by Cheryl Cruwys

30 May 2016 -  Limoges, France
Almost one year ago, I attended my first ever mammogram examination.  With no family history of cancer, having never smoked cigarettes, eating a healthy diet and being of average weight, I was confident that I would receive a 'normal' mammogram result. The radiologist completed the mammogram; indeed, 'normal' - no abnormalities. However, I was directed to the next room where I received an ultrasound examination.  A small shadow was detected on my left breast, perhaps no reason for concern, maybe a cyst? An appointment was booked for a biopsy. One week later, I was diagnosed with breast cancer - an 8mm Invasive Ductal Carcinoma (or IDC).

Early Detection
Apparently I was lucky!  Of course, to be diagnosed with cancer was a huge shock. However, what was clear was that without supplemental screening ultrasound, my tumour would not have been detected.  Unfortunately, ultrasound is not offered in the national screening programme in the UK unless a woman presents symptoms.  My next screening mammogram would have been 3 years on and the outcome would likely have been quite different.  

Knowledge is Power
Immediately I began to research IDC.  I needed to educate myself.  As a retired teacher, I wanted to learn all about breast cancer.  I was surprised and fascinated to discover the issue of dense breasts.

Why Does Breast Density Matter?
I discovered that breasts are made up of glandular and fatty tissue and whilst dense breasts are not abnormal, mammography is not as effective detecting cancers in women with highly dense breast tissue.  On a mammogram image, dense tissue appears white, but so does cancer, almost like a fog.  Cancers can go undetected and sometimes women are diagnosed later with interval cancers at a more advanced stage which require more treatment.

Supplemental Ultrasound
I live in France and national screening begins at the age of 50.  For many years, mammograms and ultrasound have been coupled.  If you receive a negative or clear mammogram, and you have dense breasts, it is likely that the radiologist will immediately carry out an ultrasound examination to be thorough. National screening public information leaflets state this to educate women on what to expect.  First a mammogram, possibly followed by an ultrasound.

My Treatment - Positive Health Outcome
In July 2016, I had a simple operation, a lumpectomy to have the tumour removed and starting in September, I underwent 35 radiotherapy sessions.  My breast cancer experience was strangely a 'good' one; and I constantly remind myself it could have been so different. I continue to have regular checks - mammograms AND ultrasound.

Breast Density Matters UK - Campaign 
During my research, I found a woman in the UK, who had dense breasts. She had found a lump and she had decided to have a mastectomy.  She discovered by chance (seeing her medical notes) that within the removed breast, there had been a large tumour hidden in her dense breast. I contacted her and discovered that she had begun a Breast Density campaign back in 2013.  In fact, I found more women in the UK who had dense breasts; who had received 'normal' mammograms, and then later been diagnosed with more advanced cancers.  I had avoided all of this.  Not only was I lucky but I was totally compelled to do something. I decided to re-launch the Breast Density campaign. 

Our Mission
In one year, Breast Density Matters UK has gained worldwide support from breast cancer survivors as well as breast cancer experts; surgeons, radiologists, scientists, and cancer organisations who promote patient empowerment.  We believe that women NEED to be educated about their breast density in order that they can make an informed decision about their breast health. Doctors and other health experts also NEED to be educated on the related risks of dense breasts.  We are attending conferences around the world and encouraging influencers in the world of cancer to educate and debate; ultimately promoting early detection.

My Motivation
I consider my breast cancer journey a short, 'easy' and pain-free experience.  My inspiration and motivation comes from women who were not offered ultrasound on dense breasts; whose cancers were detected later; women who have undergone mastectomies; chemotherapy, reconstruction and whose cancers have perhaps spread, metastatic cancer. Indeed, women who have died from breast cancer. Every day in the UK, women are given 'clear' mammograms; whilst this may be true for some; for others, perhaps with dense breasts, there will be a cancer tumour present, left undetected.  In the UK, up to 3,500 breast cancer tumours could be 'missed' each year.[1]

Join the Breast Density Conversation!
Breast Density Matters UK - educating on dense breasts with the mission of early detection; reducing later stage cancer diagnoses and saving lives. The campaign is gaining momentum and if you would like to join the breast density conversation or you would like to know more please contact me.  I would love to hear from you.   

#TLC  Touch, Look, Check.

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[email protected]

Breast Density Matters UK

@Cheryl_Cruwys

[1]  Laura Donnelly, Health Editor, 09 March 2016 http://www.telegraph.co.uk/news/nhs/12189095/NHS-breast-cancer-tests-miss-3.5k-tumours-a-year.html (calculation based on ASTOUND study findings: http://ascopubs.org/doi/abs/10.1200/JCO.2015.63.4147