Closing the book on my breast cancer screening journey
Results and reflections
My breast cancer screening journey has finally ended …for now. Last week, I met with my family physician to learn the results of my breast biopsy. This appointment was the culmination of a six-month journey that began with a routine mammogram.
My doctor entered the room and uttered two wonderful words: good news. The news was truly as good as it gets: no cancer, no further testing, and no changes to my long-term breast cancer screening schedule. The pathologist report said that it was fibrous tissue, a normal component of “dense breasts”.
Phew. The feeling of relief was intense. I realized that I’d been carrying more anxiety than I had admitted, even to myself. It could have easily been bad news, for 1 in 8 women will face breast cancer at some point. My journey would have been very different if I had been one of the unlucky ones.
My case was a classic “false positive” - a moderately suspicious mammogram finding that was later exonerated through a tissue biopsy. Stories like mine are incredibly common and are a major downside of the imperfect tools we use to find early breast cancers.
Today, I’m inviting you into the last chapter of my screening journey (for now). I’m keen to share the scientific and emotional insights that I gained along the way, from how radiologists classify breast cancer lesions to why emotional support is critical.
Two weeks ago, on my long-awaited biopsy date, I was in good spirits when my husband drove me to the British Columbia Cancer Agency. It felt great to finally be on the way to clarity after spending so long in limbo. The procedure went smoothly but was very uncomfortable, to say the least. Imagine lying face down on a hard table and having one breast tugged through a hole in the table and held in a painfully tight vice grip. Then, imagine being told to relax and stay still for what feels like an eternity (10-20 minutes) while you’re poked first with freezing needles, then by biopsy needles that suck out tiny bits of tissue. The healthcare workers were highly skilled and knowledgeable, but their warmth, kindness and empathy made all the difference. They offered a warm blanket for comfort and words of encouragement that made me feel seen and supported.
Note: Not all breast biopsies are as brutal as mine! My suspicious lesion was in a hard-to-reach spot that was only accessible using special equipment.
On the drive home, I felt a confusing potpourri of emotions: relief, anxiety, vulnerability, and dissociation from my body. I normally feel strong and connected to my body, and it was disturbing to surrender to others for painful squeezing, poking and prodding. That day, I was deeply grateful for my husband’s presence and gained a new appreciation for the importance of companionship when dealing with health issues. Over the next week, I healed and waited for my results.
While in limbo, I deepened my understanding of how mammographic images are classified and what this means for cancer risk. I learned from a retired radiologist (thanks, John!) about a standardized system called BI-RADS (Breast Imaging Reporting and Data System) that radiologists use to classify breast lesions and make biopsy recommendations. A higher BI-RADS number indicates a greater suspicion of cancer.
In general, BI-RADS risk categories (from radiologists) align well with biopsy results (from pathologists). For example, a large study found that 22% of BI-RADS 4B lesions were cancerous when biopsied; this category is used when the radiologist judges the risk of cancer to be 10-50%. In the same study, 69% of biopsies from findings categorized as BI-RADS 4C came back as cancer; this category is intended to capture a 50-94% chance of cancer. It was a similar story for other BI-RADS categories.
My doctor never mentioned the BI-RADS classification system. When I raised it during our biopsy results discussion, my doctor told me that she had opted not to disclose my risk category (BI-RADS 4B) before the biopsy for fear of causing more anxiety. This paternalist approach doesn’t sit well with me. I’d much rather have rough estimates than be left wildly speculating on what “moderate risk” means. I’m a big believer in empowering people with data, context, and thoughtful communication. Some people may prefer not to know, and that’s fine, but I think we should have a choice.
Note: The moderate risk BI-RADS score for my mammogram was moot after my biopsy results came back clean, as tissue pathology is the gold standard for diagnosis. Still, I wanted to know my full story and understand why this wasn’t discussed earlier.
While I disagree with my doctor’s risk communication approach, I was impressed with the way she supported me through the outlandish wait times of our broken system. She encouraged advocacy and repeatedly reminded me that I deserve better. In her words: “I hope you know that this [lack of care] is not okay.” Comments like these lifted my spirits and my sense of self-worth when I was feeling frustrated, powerless, and vulnerable. So, I’m passing my doctor’s message along to you. You deserve excellent care. We all do.
Thanks for following my journey and sending well wishes along the way. While I’m thrilled to conclude this diagnostic saga, I’m grateful for the lessons and perspectives I’ve gained. I appreciate my health, my vitality and my supportive community more than ever and feel better equipped to support others. My heart goes out to all of you whose diagnostic sagas ended with bad news, not good news. No matter where you are on your health journey, I wish you all the best and hope you get the care, information and support you deserve.
Questions, comments, and shares are all appreciated.
Yours in science and in heart,
Chana
Thank you for sharing this great news and the details of your experience!
Such good news! What a relief!! I appreciate you sharing your experience with all the clinical details. Having read this will help if something similar happens to me and many others reading this. Thank you, Chana <3