The Best-Kept Secret
By Nancy M Cappello, Ph.D.
My Story
On February 3, 2004, I was diagnosed with stage
3c breast cancer within weeks of a ‘normal’ mammogram. What I have learned since my diagnosis
is that I have dense breast tissue and wasn’t
aware of its significance as:1) Mammography misses every other cancer indense breasts as cancer appears white on a mammogram and dense tissue is white-thus there isno contrast to detect the cancer and2) the mammography report that is written by theradiologist to the referring physician, which hasdetailed information about a woman’s breasts, isseldom shared with the patient.
Just seven weeks prior to my late stage
cancer diagnosis, I had my 11th yearly
mammogram & the ‘happy gram’ report statedthat my mammogram was ‘normal.’ At a subsequent annual exam, my doctor felt a ridge in mybreast and ordered a mammogram. The
mammogram revealed ‘nothing’ but that same
day the ultrasound detected a quarter-sizelesion. The pathology report revealed
advanced cancer metastasized to 13 lymph nodes.
What happened to Early Detection?
Because cancer was detected at such anadvanced stage, I endured an aggressive
treatment consisting of chemotherapy,
radiation, numerous surgeries & hormone
therapy. Since my diagnosis, I am compelled toexpose the BEST-KEPT SECRET about dense
breast tissue and its significance asmammography is limited by dense tissue & dense
breast tissue is a predictor ofbreast cancer risk.

****‘To withhold a woman’s breast tissue
composition from her is denying her theright to make an informed decision about
her breast health.’(Cappello, N. J Am Coll Radiol 2013; 10:903-908)

AWARDS AND RECOGNITIONA Citation by the Connecticut General
Assembly in recognition of ‘extraordinarycommitment to promoting early detection of breast cancer
through successful legislative
advocacy and public awareness and for thecourage to transform a personal tragedy into a
positive force.’
Parade Magazine-Health Hero
Person of the Year-Litchfield County Times
Angel Award-American Cancer Society
Ruby Award-Soroptimist
Health Care Leadership Award-Waterbury Chamberof Commerce
Women of Strength Award-Get in Touch
Foundation
Aixplorer Achievement Award-SupersonicImagine
State Health Advocacy Honoree-St. Vincent’s
HospitalMaking a Difference Award-Safe Haven of Greater
Waterbury
Pink Pioneer-Pink Paper Publication
Women of Innovation—CT Technology Council
Women Making a Difference—Griffin Hospital
Nancy Pilver Breast Advocacy Award
Congressman John Larson

MEDIA AND SPEAKING ENGAGEMENTS

Dr. Cappello is a featured speaker
across the U.S. & has lectured in Puerto Rico, Canadaand Italy. Her message, conveyed with inspirationand humor, speaks of her journey from patient toadvocate. Her story inspires others to take challenges
and life’s lessons to make social change.
Dr. Cappello’s tragedy of her advanced breast cancer,
resulting in Connecticut’s landmark legislation & thenational grassroots legislative efforts, are featured inbroadcast & print outlets such as ABC, CBS, Fox,Prevention, NY Times, Wall Street Journal,
Huffington Post & NPR.

There are too many women who areunaware of their breast density, believe their‘happy gram’ when it reports ‘normal’ andare at risk of a later stage cancer diagnosis.
Be informed about your breast density.
Cancers detected EARLY have better
treatment and survival outcomes.
The MISSION of Are You Dense Inc. is toeducate the public about dense breast tissue and its
significance for the prevention of later stage cancers.

* Forty percent of women havedense breast tissue.

* Breast density predicts theaccuracy of a mammogram at
any age.
* Mammography misses every
other cancer in dense breasts.

* Breast density is awell-established predictor ofbreast cancer risk.
Are You Dense Inc.
a 501(c)(3) Public Charity

AreYouDense.org
info@AreYouDense.org© 2005-2015, Are You Dense, Inc. All Rights Reserved.

HOW DO I KNOW IF I HAVEDENSE BREAST TISSUE?
A Radiologist determines the density of awoman’s breast by examining amammogram. Dense Tissue is comprised ofless fat & more fibrous & connective tissue &appears white on a mammogram. Cancer
also appears white & can be masked by densetissue. Request a copy of yourmammography report from yourreferring doctor. Make sure it is thereport that is generated by theradiologist and not a form letter. Read thereport carefully. Look fordescriptions of your breast tissue.

D.E.N.S.E.®

There are two BIRADS (Breast ImagingReporting and Data System) scales that areused by radiologists to standardize
mammography reporting. The following ACR
BIRADS® 5th Edition categorizes breastDensity.
aThe breasts are almost entirely fatty.

b

There are scattered areas of fibroglandular
density.

c

The breasts are heterogeneously dense, which
may obscure small masses.

dConnecticut was the first state tomandate that each mammography reportprovided to a patient includes information
about breast density. For information aboutstate, federal & regulatory efforts visit
AreYouDenseAdvocacy.org.

Discuss with your doctor your breast
tissue composition. Most likely themammography report that you receive
will not contain this information .
The other BIRADS scale categorizes thefindings that are seen on the mammogram.
Most mammography reports reference thisBIRADS* scale.

WHAT DO I DO IF I HAVE DENSE
BREAST TISSUE?
Ask your doctor about having additional
screening studies such as an ultrasound orbreast MRI. Connecticut General
Statutes require insurance coverage forcomprehensive ultrasound screeningof an entire breasts or breasts if amammogram demonstrates
heterogeneous or dense breast tissue basedon BIRADS (Breast Imaging Reporting andData System) established by the American
College of Radiology (ACR). To determine theinsurance laws in your state contact yourstate representative or public healthdepartment and visit
AreYouDenseAdvocacy.org.

Remember to:~Have a Mammogram. A mammogram
distinguishes the density of a woman’sbreasts ~Be breast aware. Look for changes inyour breasts ~Have your physician
conduct a thorough yearly breast exam.

The breasts are extremely dense, which
lowers the sensitivity of mammography.

0Incomplete Need Additional Imaging
Evaluation and/or or Prior Mammogramsfor comparison

1

Negative

2

Benign3

Probably Benign

4A,B,C A: Low suspicion for malignancy
B: Moderate suspicion for malignancy
C: High suspicion for malignancy
5Highly Suggestive of Malignancy

6

Known biopsy—Proven Malignancy

A woman with dense breast tissue CANNOT
rely solely on the above BIRADS* scale todetermine findings of breast cancer.

* Dr. Thomas Kolb’s seminal study foundthat by supplementing
mammography with ultrasoundmarkedly increases cancer detection in
women with dense breasts. While
mammography detected 98% of cancer inwomen with fatty breasts, it found only
48% in women with the densest breasts.
(American Medical Association: 9/2002 & JAMA
Scientific Paper of the Year Award.)* Mammography misses every other cancer
in dense breasts (Berg et al, JAMA: 2012)* Breast density is consistently
associated with breast cancer risk, morestrongly than most other risk factors, andextensive breast density may
account for a substantial fraction of breast
cancer. (Journal of National Cancer Institute,Aug. 2010)* We’re finding small, mammographicallyoccult (not visible) cancers at a significant
rate & we’re able to do that & still beefficient. (ACR bulletin: Oct., 2012 ; Dr. Regina
Hooley, Yale School of Medicine)* Doctors have spoken to less than one in
10 women about breast density.
(Harris Interactive Survey, 2010)

For more information
contact:
Nancy M Cappello, Ph.D.
Director and Founder

Are You Dense, Inc.
AreYouDense.org
Info@AreYouDense.org
Help us in our efforts to prevent later stage
cancers.
© 2005-2015, Are You Dense, Inc. All rights reserved.