I got the all-clear. The next day, I found a lump.
Last month, I had a routine mammogram.
Even when it’s routine, there’s always that little kernel of worry. You go in, get your boobs squashed between two plates in a way that feels both deeply undignified and medically necessary, then get dressed and carry on.
And wait.
A week later, the text arrived.
All clear. Nothing to see here. Get on with your life.
Phew.
On to worrying about everything else, then.
But life said, hold my gin.
The very next day, I was in the shower, washing off some lovely scented body wash, when my fingers felt something foreign.
It was like a bolt of awareness.
A lump.
I felt again.
Definitely something there.
And then came that horrible, sinking feeling.
How?
I had just had a mammogram.
Standing there with a towel wrapped around me, before I’d even got dressed, I booked an appointment online with my GP.
She couldn’t see me for a week.
I rang the breast clinic, hoping I could bypass the wait and book directly. I couldn’t. I needed to see a GP and get a referral.
So I waited.
The waiting is its own kind of awful
The day of my appointment finally arrived. I was already on my way when the doctor’s surgery rang.
My GP was sick. Could I reschedule?
I turned the car around and went home.
Another night of wondering. Another appointment, this time with a different GP, the following day.
I had convinced myself I might have to fight to be taken seriously. After all, I’d had a clear mammogram only days earlier. Would I look paranoid?
I needn’t have worried.
The GP examined me, felt the lump herself and referred me for further imaging.
They should see you in a couple of weeks, she said.
More waiting.
Except, unexpectedly, the breast clinic rang when I got home. They’d had a cancellation. Could I be there in an hour?
Yes.
Absolutely yes.
Curiosity got the better of the journalist in me, so I asked when I might have been seen if I hadn’t taken the cancellation.
Around three to four weeks, I was told.
The clinic told me a shortage of radiographers was contributing to the wait.
Three to four weeks might not sound like an eternity.
But when you’re waiting to find out whether the lump in your breast is cancer, it feels like one.
I rang my partner at work. He got straight in his car to come and be with me.
The room nobody wants to be sitting in
There is something about the waiting room at a breast clinic.
Most women who have sat in one probably know the feeling.
You look around and wonder if your life is about to change.
There were women sitting alone and others, hearteningly, with partners beside them.
I was incredibly grateful not to be alone.
Eventually, I was called through.
This time, instead of the standard mammogram I’d had the week before, I had 3D mammography, also known as tomosynthesis. A small marker was placed over the lump so the imaging team knew exactly where to look.
There wasn’t much reassurance offered.
Which, in hindsight, makes perfect sense. They didn’t know yet.
But when you’re the half-dressed woman standing there wondering whether she has breast cancer, every facial expression suddenly feels loaded with meaning.
Back to the waiting room.
I asked who would tell me what they’d found.
The radiologist doing my ultrasound would talk me through the results, I was told.
By the time I was lying down for the ultrasound, my anxiety was through the roof.
The radiologist was calm and matter-of-fact. She moved the ultrasound probe over my breast, examined the area and, after a few minutes, gave me the words I’d desperately wanted to hear.
Everything was okay.
The lump was a fluid-filled cyst.
Relief.
Huge, glorious relief.
But the conversation wasn’t over.
“You have very dense breasts”
The radiologist told me I had very dense breast tissue.
I knew almost nothing about breast density.
She explained that breast density can make cancers more difficult to see on a standard mammogram and talked me through what that could mean for my future breast screening.
I left with recommendations specific to me about additional imaging and future surveillance.
And my relief began to make room for another emotion.
Confusion.
How had I reached 48 without knowing any of this?
Why had no one told me this sooner?
I’d done what women are constantly told to do. I’d attended my mammogram. I’d received the reassuring result.
Yet until I happened to find a benign cyst the following day and underwent further investigation, I didn’t know I had dense breasts.
I didn’t even know that knowing my breast density might be important.
So I did what journalists do when something doesn’t quite add up.
I started asking questions.
And what I learned is something I think more women need to know.
So, what exactly are dense breasts?
It turns out breast density has nothing to do with how your breasts look or feel.
“You can’t tell by feeling them,” Community Breast Nurse Educator Debra Leutenegger says.
Breasts are made up of fatty tissue as well as fibrous and glandular tissue. The greater the proportion of fibrous and glandular tissue, the denser the breast.
Younger women generally tend to have denser breasts and, for many, breasts become less dense with age. But that doesn’t happen for everyone.
And here’s where it matters.
On a mammogram, fatty tissue appears darker or grey. Cancer, however, can appear white.
Dense breast tissue also appears white.
“You’ve essentially got white on white,” Leutenegger explains.
That can make a cancer more difficult to see on a mammogram.
But masking is only part of the story. Higher breast density is also associated with an increased risk of developing breast cancer.
Suddenly, the conversation I’d had with my radiologist made a lot more sense.
But it also brought me back to the same question.
Why didn’t I know mine?
A clear mammogram doesn’t mean stop paying attention
This was perhaps the biggest lesson for me.
I found my lump the day after receiving my all-clear.
Had I let that text override what I could feel under my fingers, I could easily have told myself it was nothing.
Leutenegger says women need to understand the difference between breast screening and investigating a symptom.
A routine screening mammogram is for women without breast symptoms.
“If you have a symptom, no matter what age you are, your first port of call should be your GP, not your screening mammogram,” she says.
And a recent clear mammogram shouldn’t stop you.
A mammogram, Leutenegger says, is essentially a snapshot in time. Changes can occur between screenings and some abnormalities may be more difficult to see than others.
Finding a lump doesn’t automatically mean breast cancer. Most breast lumps are benign.
Mine was.
But I couldn’t know that standing in the shower with my fingers pressed against it.
Ask questions. Lots of them.
One thing this experience has changed for me is the way I think about breast screening.
I used to think of a mammogram as something fairly binary.
You went. They looked. You got the result.
Clear or not clear.
Now I know there are more questions worth asking.
What is my breast density?
What does that mean for me?
Is my current screening appropriate for my breasts and my individual risk?
Would any additional imaging be appropriate?
And if I notice a change, what happens next?
Because there isn’t just one way to image a breast.
Standard mammography produces two-dimensional X-ray images. Three-dimensional mammography, or tomosynthesis, takes multiple images through the breast, allowing the tissue to be viewed in greater detail.
Ultrasound uses sound waves rather than X-rays and can provide additional information when a particular area is being investigated.
MRI and contrast-enhanced mammography are other tools that may be appropriate in particular circumstances.
But here’s where things get complicated.
If you have a breast symptom, such as a new lump, your GP can refer you for diagnostic imaging. With a GP referral, women can access the public pathway for investigation.
If you are well and have no symptoms but want additional screening because you have dense breasts, the situation is different. Private screening is available, and some providers allow women to self-refer for screening imaging, but that can mean paying for it yourself.
There are publicly funded additional screening pathways for some women considered at higher risk, including because of certain genetic or strong family-history factors. But having dense breasts alone does not automatically give you access to publicly funded supplementary screening.
And that raises an uncomfortable question about access.
Information is empowering, but what happens when acting on that information comes with a price tag?
Breast Cancer Foundation NZ is among those asking that question. The Foundation has called for women to be routinely informed of their breast density and for supplementary imaging to be funded for women at high risk.
For some women, additional private imaging will be affordable. Others may have health insurance.
Many won’t.
Don’t be afraid to be the annoying patient
Leutenegger is a big believer in women asking questions and advocating for themselves.
“Be a little bit like a dog with a bone,” she says.
It’s advice I love.
But it also worries me.
I’m pretty confident by nature. I’m not usually afraid to ask questions, challenge something I don’t understand or keep asking until I get an answer.
And even I wondered whether I would be taken seriously.
I had a clear mammogram result sitting on my phone. Who was I to turn up days later saying, Yes, but I can feel something?
I was lucky. The GP I saw was excellent. She listened, examined me, felt the lump herself and referred me without hesitation.
I want every woman to have that experience.
But I’ve heard too many stories where they haven’t.
So what happens to the woman who isn’t naturally confident? The one who doesn’t want to make a fuss, worries she is wasting her doctor’s time, or walks away when she is told everything is probably fine?
That troubles me.
We shouldn’t have to become experts in our own healthcare just to make sure we are heard. We shouldn’t need the right personality, the right words or the confidence to push back when something doesn’t feel right.
But here we are.
So ask the questions.
What does this result actually mean?
Do I have dense breasts?
Should I be doing anything differently because of my individual risk?
And if something still doesn’t feel right, say so.
Then say it again if you need to.
Knowledge is power
There isn’t a single breast screening plan that is right for every woman.
Age, breast density, family history and other individual risk factors can all be part of the conversation about what screening or further imaging may be appropriate.
And none of this is a reason to stop having routine mammograms.
It is a reason to understand what mammography can and cannot tell you, and to have better information about your own breasts.
Leutenegger uses a simple reminder: TLC.
Touch. Look. Check.
Know what your breasts normally look and feel like. If you notice something new, whether that is a lump or thickening, a nipple or skin change, unusual discharge, a change in the shape of a breast or another persistent change, get it checked.
For me, this entire conversation happened almost by accident.
A harmless cyst sent me back through the doors of a breast clinic less than two weeks after my routine mammogram.
I walked out knowing I didn’t have breast cancer.
But I also walked out knowing something about my own body that I hadn’t known when I walked in: I have very dense breasts.
And I keep coming back to that.
What if I hadn’t happened to run my hand over that particular spot in the shower?
I would have carried on, reassured by the all-clear on my phone, without knowing my breast density or that it could make a cancer more difficult to see on a mammogram.
That doesn’t mean mammograms don’t matter. They absolutely do, and I’ll keep having them.
But surely information matters too.
Knowledge is power.
Knowing your breast density doesn’t mean you have breast cancer. It doesn’t mean you need to panic or immediately book every scan available.
It means you have another piece of information about your own body and your own risk. Information you can take to your doctor, ask questions about and use to make informed decisions about your breast health.
Because when it comes to breast cancer, finding it earlier matters. Early detection is associated with substantially better outcomes, and finding a cancer while it is small can also mean less invasive treatment.
I was lucky. The lump beneath my fingers was nothing more sinister than a cyst.
But it gave me information I wish I’d had years ago.
I know I have dense breasts.
I know what that means.
And now I can make decisions accordingly.
Every woman deserves the opportunity to do the same.
A note on breast health
This article is for general information and does not constitute medical advice. If you notice a new lump or any other change in your breasts, or have concerns about your breast health, talk to your GP or healthcare provider rather than waiting for your next routine mammogram.
For breast health information and support, visit Breast Cancer Foundation NZ. For information about free breast screening, eligibility and screening locations, visit BreastScreen Aotearoa.
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