JoAnn Pushkin did what any dutiful, informed, health-conscious women over 40 would do. She had annual mammograms and performed monthly self-exams on her breasts. Year after year, she'd receive in the mail what she refers to as a "happygram" -- a report with the same six words: "Normal/Negative -- No evidence of cancer." She'd breathe a sigh of relief each time. No questions asked.
Mammograms are widely accepted as the best scientifically proven screening for early detection, and while there are stories of women whose breast cancer was not detected in a mammogram, Pushkin had no reason to believe she was at higher risk than anyone else. She had no family history. She swam every day, ate organic foods and never saw a symptom.
What she didn't know is that she was among the 40 percent of women with dense breasts, and that made her four to six times more likely to get cancer. "Dense" breasts have a higher proportion of connective tissue, as opposed to fatty tissue – hence the term. It also made all those annual mammograms she was receiving "practically useless," she says, because mammograms miss 40 percent or more of tumors in women with dense breasts.
But the 51-year old Pushkin didn't know any of this.
So, in 2005, when she felt a lump during a self-exam, she was not overly concerned.
A writer based in New York and mother to a teenage daughter, Pushkin felt confident the lump was "nothing."
"I had it checked just in case," Pushkin says.
The more recent mammography did not detect the lump, even though she could feel it. When a lump is palpable, doctors usually order additional testing. A follow-up ultrasound detected the lump. It was Stage II breast cancer.
The shock became nothing less than surreal when Pushkin heard her doctor say, "'Well, you have dense breast tissue. It would be difficult for us to find the lump on a mammogram.' I said, 'Wait. What?'" It was the first time she heard the term, even though her doctor would have known about her breast density from her first mammogram.
Once home, she Googled "dense breasts," and was shocked to find out that the condition made it four to six times more likely she'd have breast cancer.
Like 95 percent of women over the age of 40, Pushkin did not know her breast density.
"By the time you can feel a lump, it's not 'early stage' anymore," Pushkin says.
Nancy Cappello, an education consultant from Connecticut, has a similar story. After more than a decade of yearly mammograms that all came back with a "happygram," 58-year-old Cappello's gynecologist felt a thickening of her breast tissue during her annual exam. A mammogram did not detect the mass, but an ultrasound did. She had Stage IIIC breast cancer.