- Kristine Stone discovered a breast lump when she was 29. She underwent ultrasounds, but declined mammograms.
- Six months later, she was diagnosed with stage 4 breast cancer.
- Ultrasounds tend to detect cancer better in younger patients, but who reads them matters.
By age 29, Kristine Stone had earned her MBA and worked her way up to a position as a senior business analyst at a nonprofit organization in Seattle. “I was doing my dream job, my end goal,” Stone, now 38, told Insider.
Then she felt a lump in her right breast. Her grandmother had just undergone chemotherapy for breast cancer, so getting her checked out quickly was paramount.
But Stone said clinicians at the local hospital said she would have to have an ultrasound first, and the test found no problems. “There’s nothing to worry about,” Stone said, told the doctor, then declined her second request for a mammogram.
Stone asked for a second opinion. The answer was the same. “No one would refer me for a mammogram,” she said.
In fact, the clinicians were following the guidelines: According to the American College of Radiology’s adequacy criteria, it is “generally not appropriate” to perform a mammogram on a woman under 30 with a breast lump if ultrasound results are benign.
But Stone is now challenging those policies: Six months after her first ultrasounds, she was diagnosed with stage 4 breast cancer that has spread to her lymph nodes and bones. By then, her lump was more noticeable, her right arm and hand had gone numb, and her armpit was “super sore,” Stone said.
When clinicians told her it was cancer, Stone said she was like, “No shit. I told you six months ago. Now how do we get him out of here?
Stone is now a full-time patient
Stone underwent approximately nine months of chemotherapy. Then more footage revealed that the cancer had spread to his brain. Doctors managed to remove her, but the procedure left her with short-term memory loss.
Today, she undergoes immunotherapy treatments every three weeks which exhaust her. She also suffers from arthritis due to cancer and treatments. Stone can no longer work or drive, struggles to read and hasn’t taken a vacation “in years and years”. She lives in an apartment under her father and stepmother in Renton, Washington.
Stone tries to find solace by sewing port pillows for cancer patients, painting in oils and advocating for more extensive testing of young women who notice a change in their breast tissue.
“I hope young people will be more alert and aware, but more than anything, I hope politics and doctors will change,” she said. “Nobody should have to go through this, and if they had had a mammogram at 29, I think they would have seen the cancer.”
Stone said her current doctor has said she may be able to stop treatments this fall if tests show no signs of illness. If so, Stone – a former hairstylist – thinks she might want to volunteer to cut the hair of others who are going through or recovering from cancer.
“I wish I could help other cancer patients,” she said. “But at the same time, I’m also sick and tired of cancer.”
Ultrasounds tend to be more accurate than mammograms in younger women
Breast cancer is more common in women over 50, but about 9% of all new cases in the United States are in women under 45, according to the Centers for Disease Control and Prevention.
Dr. Laurie Margolies, head of the Mount Sinai Health System’s breast imaging center, told Insider that ultrasound is the test of choice for most women under 30, in part because younger women have tend to have denser breast tissue that ultrasound tends to detect better. the cause of a lump in such tissue.
With ultrasound in younger patients, “most often a benign cause can be easily found and no further workup is needed,” she added. “Very often the pain or lump goes away and you’re fine.”
Mammography is also not recommended as the first test for young women at higher risk of breast cancer due to family history or a genetic mutation, Margolies said. On the contrary, most of them should undergo a breast MRI, which also tends to be more accurate in dense breasts.
“Mammography is wonderful and detects many cancers and has been proven to reduce breast cancer morbidity and mortality by 40% in several studies, and is clearly the right first test for the majority of women over the age of 40-year-olds who are at normal risk,” Margolies said. said. “But for many women, that’s not enough.”
Look for a clinician with expertise in breast ultrasound
In the case of women under 30 wishing to have had a mammogram earlier, Margolies said, “it’s very likely that the mammogram would have added nothing” to the ultrasound results.
What can make a difference, however, is how your ultrasound is interpreted. Scans do not come back with clear “cancer” or “no cancer” signals, and different clinicians may have different opinions about what the image means.
“Breast ultrasound is extremely nuanced and extremely operator-dependent,” Margolies said. “It’s not always so easy to tell if something is a simple cyst versus, say, triple-negative breast cancer. Making that distinction can be extremely difficult.”
She encourages young women who are worried about a change in their breast tissue to go to a facility accredited by the American College of Radiology for breast ultrasound. And ask questions: does this center do a lot of breast ultrasounds? Are the radiologists who read the ultrasounds specialists in breast imaging?
“And then listen to your body,” Margolies said. “If it’s persistent or it’s very hard or it gets bigger, go back. Don’t be shy about going back and asking more questions.”
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