In Part I of the Listener’s breast cancer series, Sarah Catherall wrote about how our one-size-fits-all breast cancer screening programme continues to miss cancers and keep women in the dark about breast-tissue density. Here, she tells of her own experience and shares that of Ruia Jameson.
I never imagined I was at risk of getting breast cancer. I was flat chested – often I didn’t even wear a bra – and my mammograms over the years were always clear.
In my BreastScreen Aotearoa biennial mammograms I was never told that my AA-cup breasts were dense, packed with thick, glandular tissue rather than fatty tissue, with a density level of “D” – the top of the A-D scale. I really thought I had a lower chance of developing breast cancer because I didn’t have much breast tissue.
In late 2022, I wrote a story for the Listener about breast cancer and as a result of that research, decided to try a new 3D-screening technology available at Dr Monica Saini’s private clinic, Breast Institute New Zealand, in Lower Hutt. My mammogram 18 months before had been clear but something compelled me to go for one six months before I was due for another. I was 54, felt fit and had not noticed any change in my breasts. I do have a maternal aunt who had breast cancer so there is some “second-degree” family history but that was not the driver to book in; it was more curiosity about this new technology.
The procedure was the same as getting a standard mammogram: boobs squashed between two plates and images taken. My left breast hurt and I winced. The technician did a quick calculation: I had extremely dense breasts, she told me. On the mammogram, my breast tissue looked white, like a moonscape.
Following the 3D mammogram, I had an ultrasound. Saini looked at the ultrasound images on her computer, pointed to dotted white sparkles in my left breast, and said three words: “Sarah, I’m worried.”
My dense breast showed DCIS (ductal calcification in situ), a pre-cancer, but in some cases, Saini told me, the calcification does turn cancerous. I had a biopsy of the tissue and after an incredibly anxious 10-day wait the result came: stage one breast cancer. It was early and had not spread to my lymph nodes.
Over the next months, I learnt a lot about breast cancer and what it’s like for those going through it. Although screening is more extensive in the private system than the public one, I chose to have my surgery in the public system because my surgeon worked across both. The only difference was I had to wait a week longer, but I saved $45,000 (I don’t have medical insurance). I had surgery and reconstruction at Wellington Hospital five weeks after my diagnosis, on my partner Steve’s birthday.
It didn’t stop there. The cancer was out but I was whipped off HRT (my cancer was oestrogen-positive, meaning the HRT hormones were feeding it) and I’ve been on an oestrogen blocker, tamoxifen, since. I didn’t need chemo or radiotherapy: a multi-faceted team of 18 at the hospital, including radiologists, my surgeon and oncologists, assess cases each week and decide as a consensus whether someone needs it. They decided I didn’t.
When I returned to Breast Institute NZ for another 3D mammogram a month ago, I asked Saini if any signs of my cancer were there in my last BreastScreen Aotearoa mammogram. And were my breasts always dense, or had HRT increased the density?
Studying my BreastScreen mammogram, Saini couldn’t see anything suspicious. She assessed all my mammograms and said my breasts had always been dense – she didn’t think they had worsened on HRT. She also told me she has many clients on HRT and hasn’t noticed a change in their breast density.
I use my case as a warning to my friends and the women I meet. Check your boobs, don’t assume a mammogram is always accurate, and ask your mammogram technician if they can share your breast density – because knowing it might just save your life.
Unknown risk
Sitting in Wellington’s Midland Park on a sunny lunchtime, Ruia Jameson (Muaūpoko, Te Ātiawa, Ngāti Ruanui) fights back tears when remembering how she felt telling her two children she had breast cancer. They were six and nine at the time.
In 2020, six months after Jameson had her first all-clear mammogram, she found a lump in her left breast. It didn’t go away so she went to her GP, who sent her to a private clinic (through medical insurance) and she was given an MRI. She was then told that her breasts were extremely dense, a risk she had never heard of.
Says Jameson: “It wasn’t until I went to the Breast Centre for a mammogram and further testing and ultrasound, he was telling me that it was hard to see things because the tissue was so dense. That’s when I first heard about breast density. I was sent for an MRI and they found all this cancer.’’
The day New Zealand went into lockdown, she found out she had HER2 positive breast cancer. It was a complete shock. She was fit, healthy and had no family history of the disease.
She had four rounds of chemotherapy, 17 rounds of Herceptin, five operations and 15 rounds of radiation.
Now aged 50, the public-sector consultant has annual check-ups, which will end next year. “I’m so relieved I found a lump. I’m so relieved to be okay.’’
And she’s keen to get the message out to Māori wāhine to get screened, and to also ask about their density. “On behalf of all Māori wāhine, we should be told about our density. I say this for all women and I tell all my friends to ask about their density. I don’t think any women should miss out on being told about their density. But I don’t know what is available in the public system if women want more screening, so that is the dilemma.’’
