Easter 2021, while living in Brazil, I found a lump in my left breast. It was unlike anything I had felt before, but my breasts had been doing crazy things, I was 15 weeks pregnant.

It was the height of the pandemic, and my husband and I had just gotten married a few months earlier. We had met in Rio and he had finally made the move to Brasilia. I was working for the Canadian Government at the Embassy and COVID had extended my posting a year but we decided to return to Canada in the summer to have our baby. I was looking forward to the next few months and learning everything I could about becoming a mom.

I found the lump on a Thursday evening, the one before Good Friday. Thankfully, my Ob-Gyn sent a referral for an ultrasound right away ? even though she was sure it was pregnancy, she listened, and reacted. In any case, I had had a mammogram and an ultrasound about six months earlier and everything had come back clear. I had no family history of cancer. The mammogram mentioned dense breasts without explanation. Google told me that it makes cancer harder to detect and can be a risk factor. I briefly registered this information and forgot it, until Easter. On that Saturday, I was in a gown on the bed in shock as the cold gel and wand honed onto abnormal tissue and a few wonky lymph nodes. They called in an extra doctor as the tears poured down my face. I knew even without the biopsy confirmation that came a few days later.

We boarded a flight less than a week later, with my two senior cats in tow, leaving my home for the last four years without a proper goodbye; Rafael leaving his home country for mine without a hug from family. The airports were deserted. The quarantine hotel a surprising reprieve. I met my care team via Zoom and underwent 8 rounds of AC-T chemo while my belly grew, with no one allowed to accompany me. At 37 weeks our son, Benjamin, was born in September via c-section after a failed induction. He was healthy and beautiful. We were ecstatic.
10 days later, I had a lumpectomy, balancing reduction and lymph node removal. It had been a difficult decision after much conversation. My surgeon was adamant that the statistics were clear, a lumpectomy had essentially the same prognosis since I had to do radiation anyway, and the surgery was easier. It was my choice. I had spent a few hours earlier that week in the breast imaging centre at my hospital having a biopsy on other suspicious lumps that I had discovered. My wonderful tech took some images and the head of the department came in. In no uncertain terms, she said that she would not be able to tell me if I had cancer in my breast, ?it?s all snow?, she said. The mammogram showed nothing, not even the tumor we knew of. The needle punctured my skin.

When the biopsy came back benign, I settled on the lumpectomy. I would have just given birth I thought, maybe I could even breastfeed for a day or two? At my husband?s suggestion the surgeon removed all the lumps and I awoke feeling lighter and more comfortable with my choice. I was home for two days when I spiked a fever and was readmitted to the hospital. I had only just been released when the pathology came back. The breast was riddled with cancer. The other lumps were indeed malignant, the margins weren?t clear and too many lymph nodes were positive. My dense breast had hidden it all. I returned to the OR for a mastectomy and complete lymph node dissection. It was a hard taken blow. I wish I had understood breast density more fully and understood the message that the doctor of imaging had tried to impart.
The rest of my treatment followed a standard path. I started Tamoxifen and Zoladex injections. The symptoms of menopause mixed with those of post-partum. My hair began to grow back and my scars healed. 15 rounds of radiation followed, taking place over Christmas and New Years, a few extra days off in between. My son?s first Christmas was spent with family and I could not have been happier.

I started on a CD 4/6K inhibitor in February, 2022 and a year later I added a prophylactic mastectomy with immediate DIEP flap reconstruction for both breasts, I wasn?t taking risks any longer. It was a difficult and painful recovery, but just as I started to feel better, I developed another fever. My abdominal wound was infected.

While in emergency, the CT scan results came back. I had lesions in my spine and hips. My cancer had spread. I was diagnosed Stage IV. The medication I was on was working at least; the spots were now visible on the scans. I continued on the medication until January 2024 when there was spread to my lungs and additional lymph nodes. Now, I take IV chemotherapy every week for three weeks and then one week off. It?s working and I am healing so I am very grateful but I can?t help but wonder how this might have all played out differently if I had understood dense breasts after my first mammogram or when I was making my surgical decisions. Would it have changed things if my surgeon had taken my density into consideration when she advised me?

DBC Note: Jessica, our heartfelt thanks for your courage and willingness to share your story. We need to see all health care providers discuss the implications of dense breasts with their patients after a screening mammogram. Your story truly helps to educate others about understanding the risks of dense breasts. It also points to the importance of a pre-operative MRI for all women with dense breasts. Thank you so much.