At the age of 50 in December 2023 with a requisition for my first ever screening mammogram, 20+ years’ experience in diagnostic imaging, no symptoms (lump), and no family history of breast cancer, I arrived for my appointment without worry.

I began my career as an ultrasound tech in 2002. Over the years, I have performed countless breast ultrasound exams, assisted radiologists with ultrasound guided breast biopsies and helped maintain and expand a supplemental breast imaging program with Automated Breast Ultrasound (ABUS) and Handheld Ultrasound (HHUS). One of my tasks involved statistical reporting on patients with a negative (normal) mammogram that were positive (cancer) on supplemental screening with ABUS or HHUS. I never imagined that I would become one of my own statistics.

My mammogram was normal with a recommendation for repeat screening in 1-2 years. I am grateful to live in Alberta, breast density is routinely reported. Mine was reported as ACR category C – heterogeneously dense. Due to this increased density, it was also recommended that an ABUS be performed. I booked the ABUS for January 2024.
The ABUS report noted an area of potentially suspicious shadowing in the right breast that required additional investigation with targeted hand-held ultrasound.

I am still not worried. From my experience doing statistical reports, the majority of patients recalled from ABUS don’t end up with a cancer diagnosis. I am booked for ultrasound in February.

The sonographer completes the ultrasound and leaves the room to review the images with the radiologist as per protocol. She doesn’t return alone. There is a radiologist with her. Now I am worried. I have worked with this radiologist all my career. I am shown my images, and they proceed to tell me that there is indeed a highly suspicious mass in my right breast requiring a biopsy (BIRADS 4c). I am really worried. I don’t recall the rest of that conversation. I feel like I am in a movie and the sound has gone out. Things are happening around me, but it is surreal. I am thinking -this can’t be real; I am the one who is with the radiologist during this conversation. I am the one who arranges the biopsy and hands out the patient information sheet. I am NOT the one receiving a biopsy appointment!

The silent movie continues. I muster all my stoicism to tell my husband. The wait for the biopsy and then the results feel like an eternity. Going through all the motions of a normal life carrying the emotional weight of a thousand giants. Can everyone tell? Is there a chance that the biopsy will not come back as cancer? Oh God, what if it is cancer?

It IS cancer.

Invasive lobular carcinoma – the “sneaky” breast cancer. Grade 2/3. HER2 negative. Hormone receptor positive (ER+, PR+).

The silent movie stops. EVERYTHING stops. Heart drops, stomach lurches and tears flow. Gut check. Breathe. Now what?

Here we go. Dive into the deep end. An emotionally exhaustive few days followed as I break the news to family, friends and coworkers. Next is the surgical consult to discuss options based on pathology and imaging reports. I have a plan. Surgery and Radiation. Breathe a little easier. Get this thing out of my body!

On the day of surgery (February 28, 2024), I need a needle/wire localization of the tumor as it cannot be felt by me or my surgeon. A true silent lesion. I keep thinking how lucky I am to have had access to supplemental breast screening.

I underwent a breast resection with sentinel node biopsy. 4 sentinel and 2 regional lymph nodes are removed and biopsied. All surgical margins are clear, and lymph nodes are negative for metastasis. I have won the cancer lottery. Stage 1.

I wait for an oncology referral. Surgical recovery proceeds without complications. The diagnosis and surgery happened efficiently. I am now hit hard with the realization that I have not truly processed the enormity of what has happened and is still happening to me.

The wait for an oncologist appointment in this “in between” stage is extremely difficult as I desperately try to not think of all the what ifs. I dive into researching/reading about cancer support resources available to me. I found Wellspring Alberta, cancer support for patients and care givers. I immerse myself in art classes, drumming, Tai Chi, Reiki and nutrition classes. I quickly discovered that the benefit of these programs is not the activity but the people you meet who know exactly what you are feeling, thinking and worried about.

In June I received my radiation therapy plan. 9 sessions in total. 5 to the whole breast and 4 boosts to the tumor bed. I am given a prescription for Tamoxifen to take for the next 5 years. And just like that, I am done.

Can I forget this all happened? Back to NORMAL? A cancer diagnosis is hard and life altering. I continue to honor that by creating a space for cancer to walk with me but not lead me. I am proud of how brave I was and am. The changes I have experienced through this journey made me a better person and a more empathetic health care provider.

I believe that knowing what breast density meant, having it categorized and reported and most importantly having access to supplemental breast screening, in my case with ABUS, made a positive impact on my prognosis. Without these options, I would still be undiagnosed waiting for my next mammogram in 1-2 years with a growing and potentially metastasizing tumor. The surgical and treatment plan I received would have been significantly more rigorous and negatively impacted my quality of life, long term health and increased cost to the health care system to treat me.

My hope is that our stories collectively raise awareness about the importance of breast density reporting and equitable access to supplemental breast screening for women with dense breasts across Canada. Thank you, Dense Breasts Canada, for your relentless efforts to standardize provincial/national guidelines.