Blogging my breasts: Who you Calling Dense?

I’ve been threatening to write a breast blog for a few years, now. I mean, let’s face it, when it comes right down to it, who is not interested in breasts? All right. Hold on.  I see you there shaking your heads, Ms. Straight-and-Narrow and Mr. I-Don’t-Let-My-Gonads-Drive. Deny away, but I am quite sure that not so deep down, you know you’re intrigued. As a matter of fact, you’re going to keep reading this blog to find out exactly what I’m talking about. Anyway, as entertaining and pruriently enticing as a treatise on tits might be, I could never quite bring myself to write one—until now.

If I were to write a too-true confessional about my mamms, I might talk about the fact that they made an early and unappreciated appearance. I steadfastly refused to acknowledge them until my mom dragged me (not quite kicking and screaming) to Emporium for my first “bra”. As an active, trampoline-loving 4^th grader, I didn’t relish the confinement, but the buds that were tenting my t-shirts were apparently a beacon of looming adolescence crying out to be squelched. My neophyte nipples were ensconced in elastic “cups”, which basically smashed them into submission. The message was clear: Nipples shall not be seen nor imagined through clothing. And there my insistent, not-yet-womanly stash stayed—bound in foam and fabric—for many years to come.

I could mention that my girls never quite met my size expectations. With two well-endowed grandmothers, and a mom who seemed of average dimension bust-wise, I never had reason to doubt that I’d be somewhere on the middle to large end of the curve—if I ever gave it thought at all. This may sound strange, but I never considered them too small until I found out that other people did. It bothered them. I’m sorry to report, this included my mother. Any moms out there, I can advise you with 100% assurance that telling your daughter something to the effect of, “You’d have a really great figure except for those miniscule boobs of yours…” is something less than confidence-building. Don’t do it. Just don’t. There will be plenty of other folks out there all too willing to tell your scant-chested daughter that she doesn’t measure up. She doesn’t need to hear it from her own mother.

(The good news for the mammarily-challenged is that, like our well-endowed sisters, we also have fans. There are large bosom aficionados and small bust groupies <gropies?>. And then there are the equal-opportunity enjoyers who don’t care about size, they’re just happy to be there as long as we let them.)

Possibly, I would run through the various slang terms for breasts that are both hysterical and dreadful: Glandular orbs. Skin pillows.  Flesh cushions. Milk makers. Mastoid mounds. Lady lumps. Rack. Stacked. Jugs. Sex sacks. (Blog readers: please fill in here as you like. I love alternative phrasing. What are your favorite slang/jargon/ terms for mammilla? I would love to read them.)

What finally swayed me to hold forth on the keyboard to discuss my not-so-fleshy-twins in addition to the fact that it’s breast cancer awareness month, was being informed by my doctor after my yearly breast exam: You’re dense. In California it became the law as of April 2013, that if you have so-called “dense” breasts, your health care professionals are legally obligated to report to you your “condition”. 

As an average, heterosexual female I was surprised to find out that my breasts feel different from anyone else’s. I mean, mine are the only women’s breasts I’ve ever felt. I had no reason to believe that different breasts have a different feel. Apparently doctors (and breast connoisseurs like my husband) are able to feel the difference between dense and not-so-dense breasts. Until just about a month ago, I thought everyone had a somewhat firm, discoid feel to their chesticles. Apparently this is not the case.

(My husband concurs with the doctor’s opinion on my breast density which he calls “firmness”. Having amassed a sample size into the 20’s—pairs not singles—I conclude his assessment is at least somewhat well-informed. We mustn’t judge. He spent a good portion of his adult life single and he’s an excellent cook. It logically follows that he earned ample opportunities.)

So why is my doctor suddenly so eager to make this pronouncement about my breasts? Because after 30 years of doing mammography, the health care industry is finally coming clean about the limitations of mammograms for the dense among us.

Depending on the source you cite (and the sources do vary greatly), roughly 40% of women have dense breasts. This number decreases as women age. Approximately one in four post-menopausal women continue to have dense breasts. The density is consists of a preponderance of glandular tissue as opposed to adipose tissue. It’s the glandular tissue that—when the time comes, if it comes—makes milk. What it boils down to is that some of us have breasts that mean business and some of us have breasts that just look pretty and there’s a whole wide range in between.

Examples of low and high density breast tissues:

The problem with high density breasts is that tumors also have a significant density. So basically the radiologist is looking for a dense area (shows as white on the mammogram) within a dense area (again, shows as white on a mammogram). You can liken it to looking for a white, stationary airplane in a thick white cloud—it’s more or less impossible and the denser your breast tissue, the more difficult it gets. Additionally, if you have a higher ratio of glandular tissue, you have a higher chance of developing a tumor.

This all makes perfect sense—right? So my question is this: Why has it taken them 30 years to finally come out and say: Thanks for showing up. We appreciate the opportunity to squeeze and irradiate your boobs. Unfortunately, in your case, we have no way of telling if you have a nascent tumor which is, of course, the reason you’re here allowing us to do these unpleasant things to you.

I do appreciate that they’re informing us of our condition. Ahem! Better late than never, medicos. There is a risk to benefit ratio in submitting to a diagnostic that involves radiation. If you happen to be dense, the ratio is not to your advantage. In addition to the x-ray exposure, you’re wasting time and money and experiencing a concerning amount of pain and inconvenience. And on top of all that, you’re not likely to be diagnosed if you have a tumor.

I had my mammogram this month. Turns out that on the density scale of 1-4, I’m a  4. The person on the phone reporting this to me also informed me I could discuss it more when I come in for next year’s mammogram. My response: “Uhm. Next year? I’m not doing this again next year. Why would I expose myself to more unnecessary pain and radiation when you can’t see what you’re looking for? If they have a different diagnostic by then, I’ll be happy to do that. But I’m done with mammograms.” To her credit, the woman on the end of the phone was respectful and smart enough not to argue.

The good news:

They are working on new diagnostics for the dense among us. Currently, some of us are being pinged with ultrasound; others are getting scrutinized with MRI—both non-irradiating techniques. There are various molecular imaging diagnostics as well. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748346/) However, none of these methods are widely accepted, nor are they insurance-paid.

The bad news:

If you have dense breasts, you are more likely to develop a breast tumor. (How much more likely is debatable. I’ve read from anywhere from 2-10 times—a pretty gaping range.) At this time, there is no fully-certified, medically approved, insurance-covered method of breast tumor detection for dense breasts. However, the medical community is still happy to smoosh and x-ray you regardless of the fact that mammography is basically ineffective for you. So if that sounds good to you, jump on it! If you’re like me—you wait.

Being dense isn’t all bad. For example, when the time came for me to be a nursing mom, I made a prodigious amount of milk. If I let down without a bra on, a stream of milk would shoot across the room. (A nice party trick if you’re at the right party! And no, I never was.) My poor infant son would actually choke while he nursed because of the volume and force of the milk flow. It took a few weeks for him to catch up with my production.  There is also an esthetic advantage to sporting dense breasts: You get very little sag. Admittedly, this may be a function of small size. I mean—gravity is gravity. But I’ve seen small ones that sag and I have to assume, those are not dense. I also maintain the distinction of having the firmest bosom my husband has ever encountered. Although he assures me that this is a good thing, I can’t say whether it’s good or bad. I just accept that it is.

As in all things, we take the good with the bad and try to do what we can to manage the bad as best we can. For my sisters in the high density club, I recommend you find out where you fall on the 1-4 scale and along with me, make some noise about getting some new, useful diagnostics. If you want to know more about this I can recommend this site: http://areyoudenseadvocacy.org/. They also have a page on Face Book page you can like and stay abreast (had to) of any new developments (again, had to).

Five easy factoids stolen directly from the Are You Dense? Advocacy http://areyoudenseadvocacy.org/facts/ :

1.     40% of women have dense breast tissue.

2.     Breast density is one of the strongest predictors of the failure of mammography to detect cancer.

3.     Mammography misses every other cancer in dense breasts.

4.     Breast density is a well-established predictor of breast cancer risk.

5.     Breast density is a greater risk factor than having two first degree relatives with breast cancer.

My recommendation is to be aware. Know what they’re doing to you and why. And if it doesn’t make sense, object, speak up and ask for better diagnostic options.

Ladies, if it’s your lot in life to be dense, at least be smart about it!