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Mid-morning on October 13, 2011, Hollye Jacobs was getting dressed after her breast exam in Santa Barbara, Calif., when the radiologist sent a word that he wanted to see her. “When I walked into his office, I saw images of my breasts on four large computer monitors,” says Jacobs, who works as pediatric and adult palliative care nurse. “I saw what looked like a lot of snowballs.”
The snowballs were hiding tumors.
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Hollye Jacobs’ is a cancer survivor. She knew she needed an ultrasound after her mammography screening. Image credit: Hollye Jacobs Top image: An illustration photo of GE’s ABUS ultrasound machine. Image credit: GE Healthcare
Jacobs has dense breasts and her breast tissue appears white on a mammogram, the same color as cancer.
Dense breast tissue is a common physical attribute, like freckled skin or curly hair. About four in every 10 women have it. (The percentage is even higher in Asian women.) There is no way to tell whether a woman has dense breasts without a mammogram, and density can be a factor regardless of age or breast size.
Although women with dense breasts may have a four to six times higher risk of breast cancer, the real danger is the dense tissue’s ability to obscure cancers on a mammogram. “It’s literally like looking for a snowball in snowstorm,” says Dr. Jessie Jacob, chief medical officer for breast health at GE Healthcare.
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Jacob says that mammography, which uses a low-dose of X-rays to image breasts, is still the gold standard in breast cancer screening. But for women with dense breast tissue, a clinician may not see everything with a mammogram alone. That’s because dense breasts contain more “glandular elements” than fatty tissue. “The fatty tissue lets you see through, but the glandular elements can obscure masses,” Dr. Jacob says.
Compounding the issue is the fact that many women don’t even know that they have dense breasts. A new study carried out by the Working Mother Research Institute and sponsored by GE Healthcare found that while 80 percent of the surveyed women have had a mammogram, only 43 percent knew that dense tissue makes the results harder to read.
The lack of awareness about dense breast tissue is a serious matter. There are currently 19 states that have laws that require women be told if they have dense breasts and in some cases if they should potentially consider a follow up like alternate testing. More state bills are pending.
The automated breast ultrasound exam (ABUS), which was developed by GE Healthcare, takes about 15 minutes and remains the only technology for screening women with dense breasts approved by the FDA.
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A comparison of a mammography image (right) and ABUS images (top and bottom on the left). Photo credit: GE Healthcare
Ultrasound, which uses sound waves to create images of the body, is valuable since it renders cancer black and eliminates the snowball effect. (Women with suspected cancer lesions may also undergo an MRI and biopsy.)
Jacobs, the Santa Barbara nurse, knew she had dense breasts and her physician scheduled an ultrasound exam right after her mammogram. “The technician was chatty, chatty, chatty. She was so nice,” Jacobs wrote in her blog The Silver Pen. (She has published a book, The Silver Lining, about her bout with cancer.) “Then, she stopped talking. Silence. This, I knew, was not a good sign.”
Jacobs is now a breast cancer survivor and an advocate for educating women about the disease. “You don’t know what you don’t know,” she says. “I was a marathoner with no risk factors and no family history, and my diagnosis came as a shock. You have to listen to your intuition, and if you feel that something isn’t right, then it’s not right. Pursue all avenues to get you questions answered.”