This diary contains information that you need to know if a) you are a woman with dense breasts, b) you have children who will one day grow up and become sexually active.
The two aren't related, as far as this diary goes, but the info contained hereunder is important. I feel compelled to share it for you to incorporate into your own understanding and decision-making.
HPV first. A friend has been recently diagnosed with throat cancer. His particular cancer was caused by HPV. His doctors tell him that recent studies show a linkage between these two diseases, as well as a surge in the number of throat cancers diagnosed in younger people.
Researchers blame HPV for rise in throat cancer
...With 6,000 cases per year and an annual increase of up to 10 percent in men younger than 60, some researchers say the HPV-linked throat cancers could overtake cervical cancer in the next decade.
You can find a bunch more on this, but the upshot is that when you are considering whether or not to get your daughters vaccinated against HPV, you should take this into account. And you should consider vaccinating your sons. Both men and women can get throat cancer, and the article quoted above links the current increase to the change in sexual practices (increase in oral sex) that occurred when these 50 and 60 year olds were coming of age.
Now, on to breast cancer detection in women with dense breasts.
A recent JAMA article questions whether or not breast cancer screening "works" given that breast cancer death rates have not dropped as much as one would expect if screening was effective.
There are lots of caveats about that analysis but I'm going to skip that here just to say these things:
If you have radiologically dense breasts, you have an increased liklihood of breast cancer. If you don't know if your breasts are dense, ask your radiologist at your annual mammogram (assuming you get one).
Studies that used quantitative measurement to classify mammographic patterns have consistently found that women with dense tissue in more than 60-75% of the breast are at four to six times greater risk of breast cancer than those with no densities. These risk estimates are independent of the effects of other risk factors and have been shown to persist over at least 10 years of follow up. Estimates of attributable risk suggest that this risk factor may account for as many as 30% of breast cancer cases.
(My bolding.)
Also, from the NEJM
As compared with women with density in less than 10% of the mammogram, women with density in 75% or more had an increased risk of breast cancer (odds ratio, 4.7; 95% confidence interval [CI], 3.0 to 7.4), whether detected by screening (odds ratio, 3.5; 95% CI, 2.0 to 6.2) or less than 12 months after a negative screening examination (odds ratio, 17.8; 95% CI, 4.8 to 65.9). Increased risk of breast cancer, whether detected by screening or other means, persisted for at least 8 years after study entry and was greater in younger than in older women. For women younger than the median age of 56 years, 26% of all breast cancers and 50% of cancers detected less than 12 months after a negative screening test were attributable to density in 50% or more of the mammogram.
Mammography isn't so hot at finding cancers in dense breasts.
In breasts with fibroglandular or dense pattern, the sensitivity was 60% [Mammography] and 81% [MRI](p < 0.001), and the PPV was 78% and 71% (not significant), respectively.
My translation: Mammography missed 40% of tumors in dense breasts, MRI missed 19%. Big difference. MRI's PPV (Positive Predictive Value) isn't great because it picks up some things that aren't cancer and can't tell you what they are, requiring more testing. Mammography is more specific: It is better at telling you whether or not the thing they did find is cancer. But less likely to find it, period.
This stuff is confusing and can be scary. I have a very difficult clinical exam (a specialist rated it 9 on a scale of 1-10 where 10 is the most difficult exam--hard to find a tumor due to dense and cystic tissue). But this specialist told me I don't qualify for MRI, because my risk was less than 20%.
ACS recommends MRI if your lifetime risk is 20% or greater. Yet the Gail model, which estimates lifetime risk of breast cancer, does not include the important risk factor of density. If your risk is 15-20%, it's a decision to be made with your doctor, based on a number of factors, one of which is dense breast tissue.
For me it was a no-brainer. I made the decision, with my doctor, who is a) smart, b) up-to-date on research and c) listens to me and works with me, to get an MRI. I discussed it with my mammography radiologist, who is great to work with, and he gave me his perspective and a recommendation of who in town had been doing breast MRI the longest and who he thought was best, and with the radiologist who did the MRI I ultimately had. Right now I am on an every-two-year MRI track based on my specific physical characteristics. I continue to get an annual mammogram, and twice-yearly clinical exams. Yes, I might still miss something, but I rest well knowing I've made the best decision for me. The rest is up to fate.
I know this is an expensive test and that a false positive can be very scary. I've had false positives in other situations and I know the panic, absolute panic that ensues. But I am prepared that the MRI will find something that will turn out to be benign, and that is a risk that I personally am willing to take. I think the psychological benefit of a negative finding is pretty great too. I never had much faith in a negative mammogram, after a negative MRI I don't worry much about what might be lurking in my breasts.
There is a lot to consider and sift through, and each woman will decide for herself. But I had to look hard for this info; it is not something that even experts in breast cancer are all on top of, and you should consider and weigh this information with a doctor you trust. How to pay for it if your insurance will not is a significant issue that is not covered by this diary. It's a big problem, though.
I hope this info doesn't panic anyone. I figure it's better to be informed. I am close to several breast cancer long-term survivors, and I know that as scary as this disease is, it does not have to be fatal, and usually isn't.
I hope this information is helpful!