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When a Mammogram Is Not Enough

By Blondell Peterson
December 2005


Pam Schmid
Pam Schmid shows the audience the size of one of her cancerous tumors. The largest was the size of two quarters side by side. (Photo by Blondell Peterson)

The NIEHS Fitness and Wellness Program sponsored a breast cancer a wareness seminar in the Rodbell auditorium on Nov. 17. The speaker, Pam Schmid, is a breast cancer surv ivor. In her presentation, Schmid used her diagnosis as an example that anyone can get breast cancer, even if they are doing all the right things to prevent it-like getting a mammogram. She rattled off the long list of all the things she did right, but still got cancer:

  • Did not smoke.
  • Exercised regularly.
  • Ate a balanced diet low in fat with whole grains.
  • Avoided hormones and caffeine.
  • Breast fed both children one year.
  • Managed stress.
  • Scored age 34 for real age instead of her actual age of 46.
  • Had her first child before age 30.
  • Maintained a healthy weight.
  • Had a career in health promotion.

She shared what she learned in her fight to survive after the diagnosis.

Schmid stressed the importance of regular breast exams, no matter how healthy one might be. According to Schmid, even mammograms do not detect all tumors, particularly in women who have dense breast tissue. She used the analogy that looking for tumors in dense breast tissue is like looking for a polar bear in a snow storm. Tumors appear white on an x-ray, as does dense breast tissue.

Density is described on mammogram report s as-fatty, minimally scattered density, heterogeneously dense or extremely dense. The last two categories are indicative of dense breasts, though there is some density in all breasts. "If you have dense breasts, it's important to know that a mammogram may not show all of your tumors," she said. "You should know if you have dense breasts (and only a mammogram can tell you that), and be diligent with self breast exam, clinical breast exam, and regular annual mammograms. Follow up any palpable lump or other identified concern with further imaging. If a facility offers screening ultrasound, it can be a valuable tool to use in addition to mammography in dense breasts. The use of screening ultrasound is not routine, but its use is being studied." Schmid also noted that digital mammography has recently been proven to be 15% more sensitive than regular film mammography in women with dense breasts.

Schmid said women should trust their own intuition, and be persistent in requesting further testing when they feel a lump. In her case, she could feel a lump in her left breast, but her doctor could not. He suggested she wait and get a follow up in six months, and she did-to her detriment. Six months later she was diagnosed with stage 2B breast cancer that had spread to her lymph nodes. Her treatment consisted of a mastectomy, five months of chemotherapy, 6 weeks of radiation, followed by 10 years of estrogen blocking drugs.

Schmid is passionate about educating women about the importance of exams and early detection. She kicked off a personal campaign in October, Breast Cancer Awareness month, to tell her story to one million women. She is building a web site for information at

Schmid wears a breast cancer pin upside down. After the presentation, she asked if anyone wondered why she wore the pin that way. She explained that when turned upside down, the emblem looks like a "V," which symbolizes victory. The bottom loop stands for the first tear a woman sheds when she gets diagnosed with breast cancer, and the color pink stands for courage.

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