Dense breasts/mastectomy/ongoing survei

My MRIs didn't cost a cent in the public system. Neither did anything else - except for the car parking (could have had Jimmy Choo shoes for the cost of that).

Hi Megs

I was diagnosed at stage 4  at the outset and presumably cancer had been missed in previous mammograms and ultrasounds due to my having dense breasts - I was having mammograms and ultrasound every two years and had a physical exam by GP 1 year before diagnosis. I had multiple tumours in my left breast, the largest being about 9cm long, so beats me why this wasn't picked up at last screen or by GP. My tumour was only moderately aggressive, so have trouble believing tumour could have occurred, grown to this size and spread to bone in under two years. But unfortunately, I will never know.

I thought the debate at the moment is around offering women with dense breasts MRI's as there is less chance of cancer being missed primarily due to the expensive nature of MRIs.  I wasn't eligible for Medicare rebates for MRI (however with the benefit of hindsight, I would have paid for an MRI if it had have been recommended),  but you definitely would be eligible for a rebate now, as they have recently changed rules so that if  you have had breast cancer already you are eligible.

I think the advice you have been given is more likely to be based on your pathology and chance of recurrence rather than risk associated with MRI dye. They use gadolinium as the dye for MRIs and they have recently found that your body can retain small amounts of gadolinium in the brain for many years after an MRI. However, they do not know if retaining these small amounts of gadolinium is bad for you or not. Personally, I would wear the risk of the gadolinium over having a mastectomy, if I hadn't have been diagnosed with breast cancer previously. Like @primek, if I was in your situation already having a cancer diagnosis, I would probably opt for a mammogram so that the chance of recurrence is lower. Everyone ways up risk differently though, so it is important to make up your own mind based on a full understanding of risks and benefits.

I think you need to talk to your surgeon to better understand the risks and benefits.

Good luck with your decision.

My understanding also is that MRIs are only covered by medicare if under 50 also. So it may be expensive for you long term for regular screening.

This was an interesting link I thought.

https://www.mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968

I guess the concern also with mri is false positive areas which will result in need for additional tests. Did the breast surgeon give in depth detail why they suggested the change. Was it due to discussion in the team?

I found my lump 5 weeks after a clear mammogram..i was very fortunate it was located near the skin so it could be felt. Biopsy was grade 2. Final pathology was grade 3. My outcomes may have been very different if it was deep in the breast. My breast surgeon reviewed my mammogram and stated even though we knew exactly where the tumor was it was invisible. Enough for me. I didn't want to live in fear of recurrence or new cancer growing without detection. I also live 500k away from closest breast mri machine so doing this for life wasn't really practicle for me.
I will always miss my breasts but have never regretted my decision.

Hi megs.. forgot to add.. I don’t know about risk of dye re MRI
but I’d be asking the surgeon about risk of recurrence in the same
breast because of the density. If you’re still not satisfied it’s right
for you, think about a second opinion. 

Hi Megs
Demanding time weighing up risks. Dense tissue is measured 
when you have a mammogram It’s calked a Bi Rads measurement. 
If you have time to google the Bi Rads scale it may help.
it Helps to see or get a copy of your reports. Dense breasts and cancer risk are in the spotlight at the moment. My second tumour
was missed because of it. I’m Er+ so can take anti hormone therapy.
Your interventions are based on your tumour pathology report when 
you have your surgery. I’d ask for a copy and get your surgeon to explain it to you.. I’ve had two mastectomies because of family history and the pathology of the tumours meant I didn’t need added
radiation Go gently..the decision making can be draining. I hope
you have a partner or friend to go to appointments with you. I find it helps in this decision phase. 

I had same diagnosis and could of had a lumpectomy but my understanding with her2 is the increase risk of local recurrence. I also had dense breasts. I went in with the decision of choosing mastectomy. Due to my family history my surgeon recommended bilateral with reconstruction.

I didn't require any radiotherapy as well clear of chest wall and no nodes. 

Surveillance for me is just physical exams. That's it. Anything suspect of pain etc is checked out.

Here's a link to the BCNA website that may help you

https://www.bcna.org.au/understanding-breast-cancer/treatment/surgery

And another 

https://www.bcna.org.au/news/2018/10/breast-density-debate-continues/


Happy reading and if you do go down the path of mastectomy here's another link to read


https://www.reclaimyourcurves.org.au/breast-reconstruction.html

Take care and best wishes with research 

Hi @Megs04, sorry you have this stress. I’m not sure your age. But, I too have dense breasts, was diagnosed at 42, have my anniversary MRI in a few months. I’m not keen on the dye. But no one has mentioned it as a possible problem. Maybe I should be concerned. But, the only way my surgeon could determine the extent of my cancer was an MRI. And monitor what’s happening. So, that’s the path for me.

Can you speak to someone else for a second opinion?

For me, I was prepared to accept the minimum amount of damage to my body for the best known result. There is a lot the surgeons don’t know. Some side effects might or might not occur. No one knows until you are down that path. 

If you’re not comfortable with something that’s irreversible (mastectomy) get more opinions. Ask more questions from your treatment team. Don’t give them the easy way out. 

Has anyone given you statistics on reoccurrence? It’s your choice on treatment, but there is nothing wrong with accepting minimal treatment now, and drastic treatment later if it’s proven to be required. 

Also, you might not need MRI and dye for the rest of your life. What happens if your Breast density changes? Menopause maybe? Or better imaging becomes available? Once again, I haven’t researched the dye, but surely it can’t be as toxic as chemo or radiation?

Hugs. Best wishes,

Ps im almost through chemo and will see reconstruction surgeon in a month then surgeon again. She said ill need to make a decision by then