It was April 2014 when longtime Atlanta resident, Ann Bruehl, aged 49 at the time, discovered a lump the size of a large grape in her breast. Even upon discovery of the lump, Ann was not very alarmed. She was consistent with annual mammograms that always came back clear and she had no family history of breast cancer.
Ann's initial assumption was that the growth was a cyst and could be drained or removed. She sought testing at Northside/Atlanta Breast Care Center and, after diagnostic mammograms, an ultrasound and a biopsy, Ann was diagnosed with stage 2 breast cancer and a tumor that stretched over 3 cm.
She wondered how a cancerous tumor could have grown so large already, considering she had a clear mammogram ten months prior.
But what Ann wasn’t aware of at the time was that she had dense breast tissue, a characteristic shared by nearly half of women in their 40s. Having dense breasts means the breasts contain greater amounts of glandular and fibrous connective tissue and a lesser amount of fatty tissue.
According to Ann's radiologist Dr. Lynn Baxter, dense breast tissue can make it more difficult to detect very early signs of cancerous tumors on mammograms, possibly allowing cancer to go unnoticed during valuable treatment time.
"Dense tissue looks white on a mammogram; cancers also look white on a mammogram, so they may not stand out against the background of dense tissue," said Dr. Baxter. "Fatty tissue looks dark gray on a mammogram, making cancers much easier to spot."
"Breast density can vary with factors such as age, changes in weight and hormone usage, but for many women it does not change throughout adulthood," Dr. Baxter added.
Once diagnosed with breast cancer, Ann was immediately referred to a breast surgeon and consulted with Atlanta Cancer Care's Dr. Colleen Austin, now retired. She received six chemotherapy treatments over the course of four months, underwent a double mastectomy and reconstruction surgeries, and received ongoing chemo treatments for another eight months after surgery.
From diagnosis to treatment, Ann received all care at Northside Hospital Atlanta and Atlanta Cancer Care.
Today, Ann has been cancer-free for close to nine years. Although she will never know whether her cancer was previously undetected on mammograms due to dense breast tissue, she is an advocate for the importance of women managing their own care to detect signs of cancer early.
Ann now encourages all women to proactively ask their doctors if their mammogram showed dense breast tissue and, if so, to ask for additional breast screenings such as ultrasound or MRI. She is also hopeful that the new FDA regulation that requires mammography facilities to notify patients about the density of their breasts, which was approved in March, will help lead to earlier detection, diagnosis and treatment of breast cancer for many generations to come.
* The health story shared here may portray atypical results of survival for this type of cancer, given its severity and stage. Atypical results are considered surviving a cancer that has less than a 50% five-year survival rate. Patients should consult an expert to discuss specific treatment plans and the possible outcomes before making medical decisions.