Her mammogram was normal, but she did have breast cancer

Survivor urges women with dense breasts to push for more testing

DETROIT – When it came to breast cancer screening, Lisa Spreder, of Grosse Pointe Woods, did what she was supposed to do: She got regular breast exams and annual mammograms.

Last fall, when her mammogram report came back normal, the mother of four thought everything was fine. But her family doctor wasn't so sure.

"He had told me that he looked at my report and even though it came back normal, it showed dense breast tissue," said Spreder.

The report said Spreder had "heterogeneously dense" breast tissue.  According to the National Cancer Institute, about 4 in 10 women do. That means the breast contains more fibrous or glandular tissue and less fat.  

That's significant for two reasons. First, women with dense breasts have a higher risk of breast cancer than women with fattier breasts. Second, dense breast tissue looks white on a mammogram. But so do tumors, making cancer that does occur harder to detect.

Spreder's doctor also knew her grandmother was a breast cancer survivor.

"He had just recently been at a seminar, and he had heard that women who have dense breast tissue and a family history of breast cancer should really go for an MRI because 3D mammograms were not picking up early stage breast cancer in women who have dense breasts," recalled Spreder.

She initially put it off, but when her mother pushed, Spreder went for the MRI.

"It lit up like a light bulb," said Spreder.

The suspicious spot was red and obvious on the MRI. It's not visible on her 3D mammogram.

"MRI picked it up, and the 3D didn't. It just didn't," said Spreder. "The 3D mammogram probably would have not picked up this small mass within another four to five years."

Because her cancer was caught so early, Spreder was able to choose a lumpectomy. She had six and a half weeks of radiation and did not need chemotherapy.

Dr. Jeff Falk was Spreder's surgical oncologist at Ascension St. John Hospital in Detroit.

"We know that mammography's not perfect," said Falk. "Certainly for young women, when the breasts are very dense, and if you add in that family history, it's really really important that you maybe do beyond just normal screening mammography."

Currently 35 states, including Michigan, have laws that require some level of notification regarding breast density following a mammogram.  Additional testing may or may not be covered by your insurance. It's important to work with your doctor to find out what tests are covered and what pre-approvals may be necessary.

Spreder's MRI was covered by her insurance, but she encourages women to be persistent.

"It would be up to your physician to recommend that and push harder.  And if it's not something covered by your insurance, there are independent places out there that you can pay cash to have an MRI done," said Spreder.

Falk urges women not to rely solely on a negative mammogram when there are other red flags.

"If they're feeling a lump. If they're having new symptoms, skin changes, nipple discharge, wrinkling of the breast tissue, of the skin, anything like that. Anything that's not normal to them, that they really pursue it," said Falk.

Spreder is forever grateful to the doctor who pushed her to do more.

"I hug him every single time I see him. I cry. I give him all the credit, and he won't take it," said Spreder. "I'm very lucky, very lucky."

Spreder has made a point to share her story with other women. 

"If you have a 3D mammogram that comes back and states that you have 'dense breast tissue,' especially if it states that it's 'heterogeneously dense,' ask your doctor if you would be a candidate for an MRI, especially if you have a family history," said Spreder. "If it saves one more person, that's my goal."

To visit the website of Acension St. John Hospital, click here.

To learn more about the implications of having dense breasts, click here.

To download a breast cancer risk assessment, click here.