In December 2015, less than six months after a routine mammogram came back clear, Siobhan Freeney was diagnosed with Stage 3 invasive breast cancer.
The cancer was only found after she noticed a “tiny tug” on her right nipple and immediately went to her doctor to get it checked out.
Ms Freeney, who is now 65, was in “terrible shock” when she was told it was cancerous. She underwent bilateral mastectomies, axillary node clearance, chemotherapy, radiotherapy and 10 years of hormone treatment. All of this was required because the cancer was not discovered previously, due to her having dense breast tissue. This refers to breasts containing less fatty tissue and more fibrous and glandular tissue.
“Had I been told that I had dense breasts, I would have ensured that I had additional supplemental imaging so my tumour would have been found much earlier,” said Ms Freeney.
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Today, September 24th, is World Dense Breast Day. It is dedicated to raising awareness of dense breast tissue and the need for breast density to be recorded to help “reduce the risk of cancer being missed”.
“I began advocating for breast density reporting in Ireland in February, 2016,” said Ms Freeney. “In the last decade, hundreds of women have added their voice to the campaign to have legislation introduced to ensure routine breast density reporting for women who have mammograms in Ireland.”
The petition has almost 7,200 names. In May, members of Lobular Breast Cancer Ireland, hosted by Senator Nessa Cosgrove, made a presentation to TDs and Senators in Leinster House asking for cross-party support for the introduction of breast density reporting.
A written submission to the National Screening Advisory Committee has been under review by the Health Information and Quality Authority (HIQA) since March, 2023. The campaign group await further feedback from the Minister for Health.
“Women in our Breast Cancer Screening Programme are not routinely notified when their mammograms indicate that they have dense breasts,” said Ms Freeney. “Even those who make a request for their breast density are often ignored and fobbed off. In the interest of early detection and shared, informed decision-making, this has to change.”
Currently, BreastCheck does not capture or report on breast density for women attending BreastCheck in Ireland. Sarah Egan, cancer awareness nurse with the Irish Cancer Society, says it is vital for women to be aware of any changes.
“In recent years, this has been an area of considerable ongoing international research,” she said. “Many clinical trials will inform the national screening programme how breast density can be incorporated safely and effectively to inform breast screening strategies in a way that is equitable for all.
“So it is important to seek medical advice if you notice any concerning changes. Nine out of 10 breast changes won’t turn out to be breast cancer, but it’s important to go to your GP if you have any symptoms and get them checked out.”
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According to a spokesperson for the HSE, half of all women have dense breasts, which is one of the risk factors for breast cancer. But while their risk may be higher for developing cancer, detecting it can be tricky as both dense breast tissue and cancer “appear white on a mammogram, which can make it more difficult to spot breast cancer in women with dense breasts”.
At present, there is no facility in the national breast screening programme to include the measurement of breast density.
”We do not measure or record breast density information on screening mammograms,” said a spokesperson for the HSE. “It’s not part of the screening process and we do not use it to guide our screening decisions. This is the same in most population-based screening programmes across Europe and globally."
A spokesperson for the Department of Health agreed and said that while some countries have introduced breast density screening programmes, “there are significant differences in international clinical opinion on the effective incorporation of standardised breast density notification into breast cancer screening”.
Further information can be found at www.hse.ie and www.densebreast-info.org
The HSE spokesperson said that in Ireland, changes to population-based screening programmes, such as incorporating breast density into breast screening, must first be evaluated by the National Screening Advisory Committee (NSAC), an independent committee.
