Nearly 20 years ago, Nikki Lucas went to the doctor complaining of breast pain. A mammogram and an ultrasound were ordered up, but the doctors found no problems.
In fact, breast pain can happen for benign reasons like normal hormone fluctuations -- it's not a common symptom of cancer.
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Doctors did mention that Lucas had "dense breasts," but they never explained what it meant, nor did they seem worried, so she didn't inquire further.
Flash forward to a Saturday morning back in March. Lucas, 43, decided to do a breast self-exam, because, well, that's what she'd always heard women are supposed to do. She had no trouble detecting a lump in her left breast.
"It was enormous," she remembers.
"Four days later, I'm at Moffitt Cancer Center (in Tampa, Fla.) and learn I have Stage 3 breast cancer that has spread to my lymph nodes on the left side."
Experts disagree on when to begin regular mammograms. The American Cancer Society calls for most women without symptoms to start regular screening at age 40; the U.S. Preventive Services Task Force recommends waiting until age 50 unless a woman is in a high-risk group.
What Lucas didn't know was that having dense breasts is a well-known risk factor for breast cancer. Dense tissue also makes it more difficult for doctors to detect tumors on mammogram images.
The good news is that women like Lucas do not have a higher risk of death from cancer than do comparable cancer patients with less-dense breasts. That was the finding in a study of more than 9,000 women with breast cancer, published Aug. 20 in the Journal of the National Cancer Institute.
Still, the key to treating breast cancer is finding it, and that's the challenge of dense breasts.
So women with dense breasts may need specialized tests such as breast MRI or ultrasound as part of their screening. Both can be helpful when trying to distinguish between fatty tissue and dense breast tissue.
This year, the FDA approved tomosynthesis, also known as 3-D mammography, another imaging system that may do a better job of detecting cancer than conventional mammography.
Tomosynthesis produces dozens of images from the top and side of each breast so the breast is seen as a series of thin slices.
The chief drawback of tomosynthesis is that patients get a higher dose of radiation -- about double the dose associated with standard mammography, according to manufacturer Hologic Inc.
"And, the resolution of calcifications is somewhat lower," said Dr. Blaise Mooney, director of breast imaging at Moffitt Cancer Center. Moffitt considered purchasing the technology but decided to wait until the next generation is released.
"It's neat technology and it will be helpful," said Mooney, the radiologist at Moffitt who read all of Nikki Lucas' imaging studies. "The doctor gets more information about the breast and that pro may outweigh the cons."
Cathy Readinger, 54, who lives in Tampa, was one of the first patients to receive the screening. She has known for years that she has dense breasts and that this could make it more difficult to find a tumor. So she has been diligent about self-examinations, annual clinical exams and screenings.
"I was excited to know I was getting a more detailed screening and that if there was a mass, it would be more likely to be detected," she said.