Breast Cancer

julio 13 2023

Meet Dr. Nila Alsheik, Medical Advisor for My Density Matters

Meet Dr. Nila Alsheik, Medical Advisor for My Density Matters July 13, 2023

Dr. Nila Alsheik, radiologist and Radiology Director of the Caldwell Breast Center at Advocate Lutheran General Hospital, Park Ridge, Illinois, knows first-hand the challenge of finding cancer in dense breasts.

“My job is to look at pictures on a computer, whether that’s from a mammogram, an ultrasound, an MRI, or a CT scan, and make a diagnosis,” she said, adding, “We’re looking for a white mass or white calcifications, and if the patient has completely white breast tissue because they’re dense, it’s like looking for a snowman in and a snowstorm.”

As if that weren’t enough of an obstacle to breast cancer screening, Alsheik also points to conflicting guidelines, noting the United States Preventative Services Task Force says mammograms should be initiated at age 50 and completed every other year. (Now a draft update to their guidelines suggest mammograms starting at 40 biannually.) But Alsheik and her partners disagree. “We recommend annual screenings, beginning at age 40, and above all, always with a 3D mammogram. I can’t tell you how many women have had cancers missed because they’re still doing 2D mammograms in major metropolitan areas.”

As a medical advisor for My Density Matters, Alsheik is hoping to empower women to advocate for themselves when it comes to getting the proper screening for dense breasts.

“If you’re dense-breasted, ask your provider to have a whole breast ultrasound on a yearly basis, every year. You can either have [the 3D mammogram and ultrasound] on one appointment time or staggered every six months, but make sure you get the additional tests that you need, they save lives,” she stated.

Alsheik also understands personally the genetic risk of breast cancer. In early 2023, when her sister and aunt both received a diagnosis for breast cancer, she learned her grandmother also had breast cancer. “They hid it from the family. All those years I labored under the delusion that I was average risk, and meanwhile, the whole time I was high risk,” she said. Looking ahead, she predicts genetic testing will become more widely used as a tool to screen patients for breast cancer.

Dr. Alsheik chose the field of breast radiology recognizing the value of screening mammograms, and when she met My Density Matters Executive Director Leslie Ferris Yerger, she was immediately impressed with her work.

“Leslie is literally trying to move mountains here across America by empowering patients to check their chart and be educated about what their density is so they can be appropriately screened,” she said. “It was really a privilege to be offered the opportunity to work with her and to work on this cause further.”

My Density Matters is here to answer your questions and make sure you are informed and empowered to take control of your breast cancer screening. Check Your Chart™ and learn more about reading your mammogram report and sign up for the My Density Matters newsletter to stay up-to-date about the latest recommendations.

Meet other members of the My Density Matters Medical Advisory Board.

mayo 15 2023

Meet Dr. Barry Rosen, Medical Advisor for My Density Matters

Leslie Ferris Yerger Breast Cancer

Meet Dr. Barry Rosen, Medical Advisor for My Density Matters May 15, 2023

Dr. Barry Rosen, breast surgical oncologist and Medical Director of the Breast Center and Cancer Prevention Program at Advocate Good Shepherd Hospital in Barrington, Illinois, is passionate about educating the public about breast cancer screening and prevention.

“The first message I think that we have to keep in front of our public audience is that mammograms save lives. But like all screening tests, there are limitations,” he said. As a medical advisor for My Density Matters, Dr. Rosen is working to spread the word about that limitation.

“The problem with mammography is that it isn’t as sensitive for breast cancer in women who have dense breast tissue,” he explained, noting that there’s a 25% to 50% chance a doctor won’t see cancer on a mammogram in women with dense breast tissue because the dense tissue masks the cancer.

Making matters worse, women with dense breast tissue are at a higher risk for breast cancer. Dr. Rosen calls it a “perfect storm of bad” and encourages women to work with their doctors to get additional testing when necessary.

“It is increasingly frustrating to see women diagnosed with breast cancer, who, in retrospect could have been diagnosed a year or two earlier, if only they had supplemental imaging beyond mammography because their breast tissue was dense,” he said, pointing women to the My Density Matters website where they can learn about density and additional screening options.

Looking to the future, Dr. Rosen expects breast cancer screening will improve with an increase in the use of abbreviated MRIs and eventually blood tests. “Cancer cells shed the DNA into the bloodstream in very, very small amounts that are now detectable. For breast cancer, we’re not there yet,” he said.

He also predicts artificial intelligence will improve the consistency of evaluating density. “A radiologist looks up on the screen at the mammograms and literally goes A, B, C, D, and I call this the ping pong effect. I follow patients who go back and forth between category B, and category C. It’s because of the subjectivity of the interpreting physician,” Dr. Rosen said.

With breast cancer on the rise worldwide, especially in younger women, Dr. Rosen hopes to see more screening at an earlier age particularly for those at an increased risk based on family history.

“The earlier we find that cancer, there’s a lower likelihood that [patients] need chemotherapy. There’s a lower likelihood that they need a mastectomy. So finding cancers early translates into better outcomes. You just have to do the right tests,” he stated.

We are grateful for the support of our entire medical advisory board.

abril 10 2023

Meet Dr. Julie Dohr, Medical Advisor for My Density Matters

Leslie Ferris Yerger Breast Cancer

Meet Dr. Julie Dohr, Medical Advisor for My Density Matters April 10, 2023

Dr. Julie Dohr, obstetrician/gynecologist at Advocate Good Shepherd Hospital, Barrington, Illinois, believes all women should have access to quality healthcare including preventative care like breast cancer screening.

“Breast cancer is a very prevalent disease and the earlier that you can catch it, obviously the best chance that the patient has for a normal life without having excessive treatment and morbidity,” she said.

As the director of ultrasound services at Novas, Dohr, Coll & Gadson Ob/Gyn Associates & Medical Spa, Dr. Dohr prioritizes educating women with dense breasts on the importance of additional tests, like ultrasound, along with a mammogram. It’s part of her daily conversations with patients.

“The tests complement each other. They pick up different things. Mammograms pick up calcifications, and ultrasound picks up little cysts and little nodules,” she said. “One [test] is not better than the other. They need to be [done] together.”

When patients run into issues with an insurance company that denies coverage for additional screening, Dr. Dohr encourages them to get on the phone and put pressure on the insurer.

“This is a law in Illinois. Do the appeals and don’t give up. The more that insurance companies learn about it and know about it, the better coverage they’ll give,” she said.

While more people are getting the message that breast density matters, Dr. Dohr recognizes there’s work to do amongst patients and health care professionals. If your doctor isn’t talking to you about your breast density, Dr. Dohr says, don’t be shy. “It’s okay for a patient to educate their doctor and tell them, I think I need an ultrasound,” she said.

She also encourages women to make lifestyle choices that help prevent breast cancer such as exercising, maintaining a healthy diet, and decreasing alcohol intake. “There’s not much you can do to change the density of your breasts, but you can do other things that can affect your risk factors,” she explained.

However, density can change with age. “As you get older, the sad thing is that the nice breast tissue gets replaced by fatty tissue. So then fatty tissue is easy to see through and it’s not dense,” said Dr. Dohr, noting, if you go on hormone replacement, it can increase your density.

You can learn more about breast density and your screening options here, and be sure to sign up for the My Density Matters newsletter, and we’ll make sure you are in the know about the latest recommendations.

Meet other members of the My Density Matters Medical Advisory Board.

octubre 26 2022

Breast Cancer Survivor Working for A Better World

Leslie Ferris Yerger Breast Cancer

Breast Cancer Survivor Working for A Better World October 26, 2022

By Leslie Ferris Yerger, CEO & Founder of My Density Matters

Beverly Vote is on a mission to change the global view of breast cancer to a world without it. She calls it the New Pink Paradigm.

“I believe it’s possible,” she said from her home in Lake of the Ozarks, Missouri, explaining she’s bringing together thought leaders for two summits focused on what the world would look like without breast cancer. It’s this great grandmother’s latest project in 30 years of working to educate and raise awareness about breast cancer.

Vote received her own education on breast cancer at the age of 37 when she found a lump in her breast. Over the course of a year, she faced four misdiagnoses due to her dense breast tissue before a doctor confirmed that the large, lemon-sized lump was, in fact, breast cancer. She underwent surgery, chemotherapy, and a double mastectomy.

The entire experience brought a range of emotions including shock at the diagnosis and then survivor’s guilt. Ultimately, it raised big questions for Vote about her future after the illness prompted her to sell her insurance brokerage agency.

“I went to a life purpose workshop, and there was a requirement to write a mission statement for your life. And so I did. My life mission statement is to help change the culture and the consciousness about breast cancer,” said Vote.

That clarity led Vote to buy a local magazine, turn its focus to breast cancer, and launch Breast Cancer Wellness Magazine. She has served as its publisher since the first issue arrived on her driveway in 2005. “Back then we were shipping them out ourselves,” she said.

Seventeen years later, the magazine has grown and is now published in partnership with the National Consortium of Breast Centers. It’s available for free in doctor’s offices and online. The My Density Matters Team is thrilled to see their CEO and Founder Leslie Yerger featured in the fall 2022 issue.

“The magazine’s about education, trusted resources, and inspiration from those who’ve had a transformational experience, how they faced their darkest times, and how they went through it,” Vote said.

For those looking for even more support, Vote hosts the annual Breast Cancer Wellness Thrivers Cruise which is meant to bring together breast cancer survivors and their loved ones along with medical professionals.

“We celebrate life. We celebrate our milestones. We celebrate each other,” said Vote, calling it life changing for many. “They walk on that cruise feeling they were not heard and understood. And they walk off with their heads held high. That freedom of laughing and being together with people that understand what they’ve been through is so empowering.”

In February 2023, the cruise will sail for San Juan, Puerto Rico for its sixteenth voyage.

Vote hopes her work also helps doctors, nurses, and technicians better understand their patients’ real struggles. “One of the greatest fears a woman has is being accepted after she’s had a mastectomy and if anybody’s going to find her desirable. And that’s one of the pink elephants in the room,“ she explained.

Aboard one cruise, Vote handed the microphone to a woman who talked to the crowd about that pink elephant.

“It was eye-opening for the doctors who heard her story and had no idea that this is one of the aspects that many women go through. Some came up to me and said that changed their lives and how they would go forth working with their patients,” she stated.

Vote’s next project is a podcast which she plans to launch in January 2023 to highlight the personal experience of breast cancer along with the New Pink Paradigm. “If we don’t have a vision for a world without breast cancer, we won’t be experiencing it,” she said.

In the meantime, Vote wants her work to continue guiding breast cancer patients to see their own future.

“I just want to remind women that they’re not helpless and that there’s real hope. I am on my journey to help women understand and create a vision in their own life beyond the diagnosis,” said Vote. It’s an achievement she’s certainly turned into reality for herself.

octubre 13 2022

Why Are We Letting This Happen?

Leslie Ferris Yerger Breast Cancer

Why Are We Letting This Happen? October 13, 2022

By Leslie Ferris Yerger, CEO and Founder of My Density Matters

Today is Metastatic Breast Cancer Day, and as a metastatic breast cancer thriver I am happy to see some attention paid to this mostly ignored yet deadly stage of breast cancer. Despite metastatic breast cancer being a leading cause of cancer death in women, only about 2-5% of the funds raised for breast cancer research is spent on studies of the metastasis¹. This is why it is so important to raise awareness of this type of cancer.

I worry constantly about women with metastatic breast cancer. Are they in pain? Are they sad or depressed? What about their children? Why did this have to happen? And how many more women will reach the final stage of breast cancer – metastatic?

I am the founder of Mi densidad importa, a nonprofit organization on a mission to empower women to find out their breast density, learn their options, and take charge of their breast cancer screening so their cancer can be found early, while still curable. Breast density is a significant risk factor for developing breast cancer², and makes it harder for radiologists to see cancer on mammograms, therefore potentially hindering early diagnosis. As the mantra goes, earlier diagnoses save lives as explained here by the American Cancer Society and hence the need for organizations like mine.

Many breast cancers are undetected by mammography alone and additional screening is required to find those cancers missed.³ We usually talk about this in terms of percentages missed, or ‘a number’ per 1000 women with dense breasts screened, and those figures vary quite a bit depending upon what study you look at, and all of the nuances involved.

But, exactly how many women is that? How many women who get their mammograms have their cancer go undetected? I have not seen it discussed or estimated in that way, until now.

A new study published by Matthew Covington, MD from the Department of Radiology at the University of Utah estimates that 267,000 women (for the year 2021) who got their mammograms were not diagnosed due to their breast density when they actually do have breast cancer (commonly known as a false negative), leaving their cancer to likely advance to a later stage, and possibly to the metastatic stage. The contrast of this ‘undiagnosed’ estimate to the number of estimated 287,850 invasive breast cancers diagnosed in 2022 is startling.

That’s a lot of women! Will you or someone you love be one of them? How many of those delayed diagnoses will wind up at Stage IV, metastatic, which is the stage from which one dies from breast cancer?

We can quibble about the number presented here or the calculations all we want, and likely someone will, but this study shines a much needed harsh light on the fact that a lot of cancer slips through mammography screening, and the consequences are dire.

And yet the FDA has still not come out with updated recommended language regarding breast density. The various ‘recommending’ bodies do not agree. And the American College of Gynecology does not recommend any additional screening for those with dense breasts.

Now I am even more worried about women today and tomorrow with metastatic breast cancer. Will they be in pain? Will they be sad or depressed? What about their children?

Why are we letting this happen?

References:

https://www.metavivor.org/research/#:~:text=However%2C%20the%20biggest%20obstacle%20is%20lack%20of%20funding%3A,of%20these%20diagnoses%20are%20metastatic%2C%20or%20stage%204.
Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 356(3):227-36, 2007
Wendie A. Berg, MD, PhD, Elizabeth A. Rafferty, MD, Sarah M. Friedewald, MD, Carrie B. Hruska, PhD, Habib Rahbar, MD. Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review. American Journal of Roentgenology. 2021;216: 275-294. 10.2214/AJR.20.24436