The Screening Situation
blog 5
This Might Be Dense:
and other stories about your girls
Welcome to This Might Be Dense: and other stories about your girls.
This blog series pulls the curtain back on a part of the body that’s been so sexualized, it’s still censored: on social media, in schools, and even in medical conversations. And yet, over half a million women die each year from breast cancer.
Censoring information about women’s bodies doesn’t protect us: it endangers us.
So, this series is both personal and practical.
It’s a love letter. A rage howl. A guidebook.
It’s a reminder that ya girls were never meant to be a mystery, especially to you.
What to do when your mammogram says “you’re fine (maybe).”
If you’ve got dense breasts and you’re over 40, you’ve probably heard this one before:
“Your mammogram was normal… but also inconclusive.”
It’s the medical version of “you’re fine unless you’re not.” And if you’ve been through literally anything in the realm of women’s medicine, you already know the tone: dismissive, vague, and just informed enough to make you feel like you should already know what it means.
So let’s clear the fog.
Because here’s what’s real: dense breasts make cancer harder to detect, and most women aren’t even told they have dense breasts until it’s too late to do anything but worry.
Mammograms are not built for dense breasts
If your breasts are mostly fatty, mammograms are pretty effective. Fatty tissue shows up dark on the image, while tumors show up white — easy to spot. But dense breasts? It’s white on white.
Dense tissue and tumors both appear white on a mammogram, which means one can easily mask the other. This is called the “masking effect,” and it’s not a minor glitch; it’s a known limitation. In fact, up to 50% of cancers in extremely dense breasts are missed on a mammogram.
That’s not a small number. That’s a flawed system.
You’re not average, so stop letting them treat you like you are
Most screening guidelines are built for people at “average risk,” but breast density alone puts you above average risk — and that’s before you even factor in hormones, history, or environmental exposures.
Here’s what makes dense breasts more complicated:
Higher lifetime estrogen exposure
More glandular activity, which means more opportunity for abnormal cell growth
Delayed detection, since cancer hides more easily in dense tissue
More interval cancers, which are the ones found between your “normal” annual screenings
And yet most women are not offered additional screening unless they ask, even if their mammogram report suggests it.
Imaging Options: Beyond the Mammogram
If you’ve got dense breasts, a standard mammogram might not be enough. Thankfully, there are other tools, though you’ll probably have to be the one to bring them up. Here’s your cheat sheet:
3D Mammography (Tomosynthesis)
This is the upgrade from the standard 2D. It takes layered images of the breast, which helps radiologists see through dense tissue a bit better. It increases cancer detection rates — but it’s still not perfect (Radiographics).
Breast Ultrasound
Non-invasive and often used as a supplemental test. It can spot tumors that mammograms miss; especially helpful for women with dense or fibrocystic tissue (Mayo Clinic Proceedings).
Breast MRI
The most sensitive imaging option available. Often recommended for high-risk patients, but also useful if you have dense breasts and something suspicious shows up. It comes with a higher false-positive rate, but it catches the small stuff early (BreastCancer.org).
Molecular Breast Imaging (MBI)
This is newer, and not yet widely available, but it uses a radioactive tracer to highlight abnormal cells hiding in dense tissue (Wikipedia). Keep an eye on this one if you’re navigating complex cases or inconclusive results.
So, what if your doctor says you don’t “qualify” for any of these?
Ask them to define qualify because qualifications are largely defined by insurance companies where the bottom line is profits, not people.
Dense breasts are a risk factor and being gaslit out of extra screening shouldn’t be part of your wellness plan.
How to Advocate for More Than the Bare Minimum
Doctors are people, and people are busy — especially doctors. Which means if you want more than a generic “you’re fine,” you may need to ask for it.
Here’s how to do that without apology:
“What’s my Tyrer-Cuzick lifetime risk percentage?” Many mammogram reports include this, but it’s rarely explained. If yours is 20% or higher, that may qualify you for MRI screening.
“Can you tell me my breast density category?” There are four: A, B, C, and D. If you’re C or D, you’re in the “dense” categories.
“Can we go over the full imaging report together?” Not just the summary. Not just the “all clear.” Ask for the notes. Read them. Bring a friend if it helps.
“What additional screening do you recommend, based on my risk and density?” Make them say the options out loud. It matters.
“If insurance won’t cover it, can you document medical necessity so I can appeal?” This is the paper trail that changes everything.
If you get pushback? Say this: “I asked you for further testing based on my breast density and lifetime risk. You declined. Please document your refusal in the chart.” A note like that in your record makes people suddenly… cooperative.
Final Thoughts: Screening Is a Practice of Self-Trust
Getting screened isn’t just about catching something early; it’s a way of saying to your body: I see you. I believe you. I won’t leave you alone in this.
You are allowed to ask questions. You are allowed to say “I’m not comfortable waiting a year.”
You are allowed to know what your breasts are made of before a tumor tells you.
Because this isn’t just about detection.
It’s about power.
And power doesn’t live in fear: it lives in information.
If this post helped you feel more informed, keep going. This Might Be Dense: And Other Stories About Your Girls is a full series: part practical guide, part personal reclamation, all grounded in research, rage, and reverence.
🧬 Understand breast tissue types
🍼 Explore milk, hormones & density
🔥 Learn how to manage pain & fibrocystic changes
📊 Decode your BI-RADS score and risk
🩻 Know your imaging options & how to advocate (current post)
💬 Say the quiet parts out loud
🌍 Understand environmental exposures & plastic’s impact
👐 Get the breast ritual PDF to care for your girls
You deserve to know your body before anyone else defines it for you.
