An Eagle-Eyed Nurse Spotted Asymmetrical Breasts on a 72-Year-Old, Leading to Early-Stage Breast Cancer Diagnosis Despite a Clear Mammogram

Despite Norris’s hesitation, the nurse urged her to undergo additional screening. The ultrasound showed nothing. But the MRI did: stage zero breast cancer, also known as ductal carcinoma in situ (DCIS).

“What that means is it’s actually not a cancer that has developed outside of the wall of a duct in a breast but rather is confined to the duct,” explained Dr. Elizabeth Comen, medical oncologist at Memorial Sloan Kettering, in an interview with SurvivorNet. “Some people consider stage zero actually cancer. Some women consider it an abnormal marker.”

WATCH: What Is Stage Zero Breast Cancer?

While DCIS is non-invasive, it can progress into full-blown breast cancer if left untreated. Treatment options vary — some women choose a watch-and-wait approach, while others opt for surgery and radiation. Norris’s MRI revealed two segments of irregular cells in her right breast, not a single lump. She chose to undergo a mastectomy and plans to have breast reconstruction in November.

During her diagnostic journey, Norris also received genetic testing, which revealed she carries the CHEK2 gene mutation — a lesser-known but significant marker for increased cancer risk, similar to BRCA1 and BRCA2.

WATCH: Where to Get Genetic Testing?

“Genetic testing started out with a very narrow field of women and men who were recommended to have it based on certain risk factors, family history of breast cancer, or other cancers, and also ethnic backgrounds,” said Dr. Elisa Port, surgical oncologist at Mount Sinai.

According to the American Cancer Society, testing can be done using blood, saliva, or a cheek swab, and about 10% of patients test positive for BRCA mutations.

Between 5% and 10% of breast cancer cases are thought to be hereditary. And about 10% of patients who undergo genetic testing will test positive for the BRCA1 or BRCA2 gene, Dr. Julie Rani Nangia, an assistant professor at Baylor College of Medicine, tells SurvivorNet.

Norris now calls herself “the luckiest girl in the world” — not because she avoided cancer, but because someone caught it early. She’s urging others not to wait.

“Trust your bodies,” she said. “Don’t listen to a doctor who says you don’t need a mammogram every year because you don’t have a family history. Every other year is fine. It didn’t work out very well for me.”

Breast Cancer Awareness Month may wind down on the calendar, but at SurvivorNet, we continuously elevate the voices of women across the breast cancer journey—from routine screenings like Hall’s to those facing diagnosis and treatment. The emotional toll of hearing “You have cancer” is profound. Navigating treatment options, managing side effects, and adjusting to life after cancer are all part of the path.

WATCH: You Have The Power To Help Define Your Future

Our Breast Cancer Dialogues series offers a space for women to feel seen, supported, and empowered. Stories like Hall’s remind us that behind every screening is a person—navigating fear, discomfort, and hope.

Understanding Your Mammogram Report and Breast Density

A radiologist reading mammograms categorizes breasts into four different categories using the Breast Imaging Reporting and Data System (BI-RADS), a classification system developed by the American College of Radiology (ACR). These include:

• Fatty breast tissue: These breasts are mainly composed of fat with very little dense tissue. Found in less than 10% of women, fatty breasts appear dark on mammograms.
• Scattered fibroglandular breast tissue: These breasts contain a mix of fatty and dense tissue (composed of glands and fibrous tissue). On a mammogram, they have dark areas (fatty tissue) intermixed with light areas (dense tissue). Around 40% of women have breasts that fall in this category.
• Heterogeneously dense breast tissue: This type of breast tissue has many areas of dense tissue and some areas of fat. Found in 40% of women, these breasts look mostly light, with some dark areas on a mammogram.
• Extremely dense breast tissue: Such breasts are almost entirely composed of dense glandular and fibrous connective tissues with very little fat. They are found in 10% of women and appear light on mammograms.

Your breasts are usually called dense on a mammogram report if they fall within the heterogeneously dense breast tissue or the extremely dense breast tissue categories.

Enhanced Screening for Dense Breasts

Women with dense breasts may not know they have it based on feeling alone. Breast density is determined by its appearance on a mammogram. Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, explains to SurvivorNet that fatty breast tissue appears gray on an X-ray. Conversely, dense breast structures appear white during an X-ray. Cancers also appear white on an X-ray, meaning the dense breast structures can mask the possibility of cancer. Luckily, advanced mammograms exist to help doctors navigate this obstacle.

WATCH: 3D Mammograms explained.

“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Lehman explains.

“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.

Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance. These tests include:

• 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
• Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer, could justify obtaining breast MRIs.
• Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.

A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify patients about their breast tissue density and recommend that they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details to share with the patient to make the communication clear and understandable.

Breast Density Doesn’t Remain the Same Over Time, Impacting Your Cancer Risk

Women with dense breasts are at a higher risk of developing breast cancer. This connection has been demonstrated time and again in several rigorous scientific studies. 1 in 6 women with dense breasts is at risk for breast cancer. Comparatively, 1 in 8 women with average breasts are at risk for this cancer. The exact reason for this difference is not fully understood.

Researchers from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston analyzed this connection in a new study.

They recruited 947 women between November 2008 and October 2020. All women were cancer-free at the start of the study and received yearly or biyearly screening mammograms. Researchers tracked the women’s mammogram reports and breast densities over time.

All women experienced a decline in their breast density during the 12 years. Two hundred eighty-nine women developed breast cancer during this time. Those who developed cancer had a lower rate of decrease in breast density than those who did not. The researchers concluded that the rate of breast density changes may indicate future breast cancer risk.

When to Screen for Breast Cancer

The medical community has a broad consensus that women should have annual mammograms between the ages of 45 and 54. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should now start getting mammograms every other year at the age of 40, suggesting that this lowered age for breast cancer screening could save 19% more lives.

The American Cancer Society recommends getting a mammogram every other year for women 55 and older. However, women in this age group who want added reassurance can still get annual mammograms.

WATCH: Mammograms are still the best tool for detecting breast cancer.

Women with a strong family history of breast cancer, a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before the age of 30, are considered at higher risk for breast cancer.

Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk of developing breast cancer, you should begin screening earlier.

Regular Self-Exams Are Helpful In Between Mammograms

A self-breast exam is an easy way to monitor your breasts for abnormalities. It involves feeling the breast for swelling, bulging, or changes in the shape of the breast or nipple.

WATCH: How to perform a self-exam.

Checking for signs of redness, rashes, or discharge is also part of this exam. If anything is found that is concerning, you should contact your doctor. It’s important to note that self-exams should be done with regular mammograms.

How AI Is Enhancing Mammograms When Screening For Breast Cancer

The artificial intelligence program that has received approval from the Food and Drug Administration (FDA), called Clairity Breast, may change the way doctors assess breast cancer risk from screening mammograms.

While not a replacement for traditional mammography, this AI-powered tool can enhance current screening practices and improve early detection efforts, according to Dr. Mary Newell, a breast imaging specialist at Winship Cancer Institute of Emory University.

“This new approach can enhance the current standard of care,” Dr. Newell tells SurvivorNet.

Clairity Breast analyzes subtle patterns in screening mammograms linked to future breast cancer risk, generating a validated five-year risk score. This score is seamlessly integrated into clinical systems, enabling more personalized follow-up care.

“We can identify patients who are at elevated risk and offer supplemental screening to them with breast MRI or other technologies as a way to increase the likelihood of early detection. It does not replace mammography, and in fact, relies on mammographic images to allow the risk assessment,” she adds.

How to do a self-breast exam.

Currently, women at average risk are advised to begin yearly mammograms at age 40. While Clairity Breast does not change these guidelines, Dr. Newell noted that it could help identify patients who may need earlier screening or additional imaging methods.

“It may allow us to identify patients who should start screening at an earlier age if they are shown to be at elevated risk,” she said. “It can also allow us to identify patients who may benefit from supplemental screening technologies, in addition to their yearly mammogram, after the age of 40.”

Unlike AI programs designed to detect cancer directly from images, Clairity Breast functions as a risk assessment tool. It does not interpret mammograms for cancer detection but instead works alongside traditional methods to pinpoint patients who may be at higher risk.

“Other AI tools are being developed that provide assistance with interpretation, helping to detect a cancer that may already be present,” Dr. Newell explained. “But most of the literature to date suggests that AI tools work best when deployed in conjunction with interpretation by a breast radiologist.”

Clairity Breast represents a promising step in breast cancer prevention, offering a new layer of analysis that helps doctors identify high-risk patients early and refine screening approaches — all while keeping mammography at the core of detection.

How is 3D mammography different?

“Now, advancements in AI and computer vision can uncover hidden clues in mammograms — invisible to the human eye — to help predict future risk,” said Dr. Lehman, founder of Clairity and breast imaging specialist at Mass General Brigham, in a press release.

Dr. Amani Jambhekar, a board-certified surgeon specializing in breast cancer and melanoma at CHRISTUS Health, says this new technology can make mammograms even more valuable.

“It may be a more individualized way of calculating breast cancer risk, which we need, as existing risk calculators do not identify everyone who is high risk. As a surgical oncologist, I am excited to learn more about this platform when it launches,” Dr. Jambhekar tells SurvivorNet.

RELATED: When Should I Get a Mammogram?

False Positives & the Dreaded ‘Callback’

If you went in for your mammogram and received a call from the doctor’s office to say more images, including MRI or ultrasound, may be required if the initial pictures aren’t clear, while worrisome, this scenario could mean a number of things. For instance, dense breasts, which we discuss elsewhere in this section, can make it hard to distinguish between fatty tissue and a tumor.

Here is how the numbers on screenings break down, according to Dr. Lehman: Of the approximately 10 percent of women who get called back, the vast majority will be absolutely fine after more imaging. Only 20 percent of those will need a biopsy, and in the end, just five percent of that group will be found to have cancer.

Here are some tips to help ensure you get the most accurate test possible:

• Go to a large and experienced center that has a good record and reputation.
• Don’t wear deodorant on the day of your mammography. It can contribute to inaccuracies.
• Keep in mind that certain factors, like dense breasts, tattoos, and breast implants, may also result in errors.

Learning More About Genetic Testing

Genetic testing for cancer is typically conducted in a medical setting, such as a primary care office or an OB-GYN clinic. However, some tests are now available for direct purchase, allowing individuals to explore their genetic risk independently.

Initially, genetic testing was recommended for a limited group of individuals based on specific risk factors, including a strong family history of breast cancer, personal cancer history, or certain ethnic backgrounds.

WATCH: Helping you understand genetic testing.

“It started out with a very narrow field of women and men who were recommended to have it based on certain risk factors, family history of breast cancer, or other cancers, and also ethnic backgrounds,” explains Dr. Port.

Guidelines from the National Comprehensive Cancer Network (NCCN) suggest that genetic testing should be prioritized for patients at higher risk for hereditary breast cancer. This includes individuals diagnosed with breast cancer before the age of 45, those with a strong familial history of the disease, and individuals of Ashkenazi Jewish descent.

Meanwhile, the American Society of Breast Surgeons (ASBrS) takes a broader approach, recommending genetic testing for all patients diagnosed with breast cancer.

These evolving recommendations reflect a growing emphasis on personalized medicine, ensuring that individuals at risk receive appropriate screening and guidance to manage their health proactively.

What If You Have the BRCA Gene Mutation?

Discovering a genetic mutation can be unsettling, but there are several options available to manage cancer risk effectively. These include enhanced screenings for early detection, prophylactic (risk-reducing) surgery to remove high-risk tissue, and chemoprevention—the use of medications designed to lower the chances of developing cancer.

Interestingly, for individuals diagnosed with ovarian cancer, carrying a BRCA mutation may provide a treatment advantage when paired with a class of drugs known as PARP inhibitors. Approved by the FDA starting in 2014, these targeted therapies have transformed the landscape of ovarian cancer treatment.

WATCH: Understanding the BRCA Gene Mutation

PARP inhibitors function by blocking the protein PARP, which normally repairs damaged DNA. By preventing this repair process, the inhibitors selectively destroy cancerous cells while sparing healthy ones, making them a powerful treatment tool.

“The PARP inhibitor prevents the repair of the [damaged] single-strand DNA break, and your BRCA mutation prevents the repair of the double-strand DNA break,” explains Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham, in an interview with SurvivorNet.

This combination of genetic insight and advanced medical therapies highlights how precision medicine continues to evolve, offering more effective, tailored approaches to cancer prevention and treatment.

Questions To Ask Your Doctor

If you have a breast cancer screening coming up or have recently had one, you may have questions you want answered. SurvivorNet suggests the following questions to kickstart your conversation with your doctor.

• Do I have dense breasts?
• Do I need to undergo additional or more sensitive screening?
• How is my risk level being assessed?
• Will insurance cover additional screening if needed?

Learn more about SurvivorNet's rigorous medical review process.

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