Margie Singleton is on a mission, and she’s got the power of an army behind her.
Singleton, who has been battling an aggressive form of breast cancer since being diagnosed in February, has her sights set on the Georgia Legislature to change the standard of care of how breast density is included on mammogram reports.
“It is statistically known that mammograms are missing cancer in every other patient with dense breast tissue,” she said. “Women need to be educated and they need to be given a choice.”
Singleton was diagnosed in February, but her story began in August 2017, when she found a lump in her left breast. She went in for a 3-D mammogram, which came back clear. Fast forward six months and she found sensitive knot in her right breast. This time, her doctor ordered a 3-D mammogram and an ultrasound.
“Two different 3-D diagnostic mammograms taken that same day missed a 3.6-centimeter tumor,” Singleton said. “The only thing that saw it was an ultrasound, and a biopsy confirmed it … In August and in February, a 3-D diagnostic mammogram – because I have dense breast tissue – missed that cancer.”
That was when she learned that not only is cancer more difficult to spot in dense breast tissue on a mammogram, just having dense breast tissue made her four times more likely to get cancer.
“Lo and behold, if you have dense breast tissue, it looks the same as cancer on the mammogram, so it’s hard for the radiologist to pick up,” she said.
Dr. William Burak is a breast cancer surgeon at Memorial Health and Singleton’s doctor. He compared finding cancer in dense breast tissue on a mammogram to finding a golf ball in a pile of snow – because both cancer and dense tissue appear white on a mammogram.
“So every person’s different, and for some women mammograms aren’t as accurate,” Burak said. “And what reduces the accuracy of the mammogram? The No. 1 factor is the density of the breast tissue. So if a woman is very dense, then it’s going to hide a cancer.”
In radiology, breast tissue density is categorized as either A, B, C or D, with C considered “dense” and D considered “extremely dense,” according to densebreast-info.org. In Georgia, mammogram reports may mention the category the patient falls under, but they aren’t required to explain what the category means.
“I can go back and look at every mammogram report I have. When I turned 40, I thought I was doing the right thing (getting annual mammograms). It just says, ‘You have breast density C.’ That’s it. Every woman I’ve spoken to, all they worry about is getting the phone call: ‘Hey, your mammogram’s clear,’” Singleton said. “I thought I was good, but no. I have C density and that put me at four times more risk of getting breast cancer. I didn’t know what that meant. I didn’t know that I could benefit from getting an ultrasound or MRI. It’s not standard on any mammograms right now.”
Singleton now lives in Savannah but spent 13 years in Richmond Hill until 2012. Her husband Jason Singleton, owns Singleton Custom Homes in Richmond Hill, and her 12-year-old daughter Jadyn attends Savannah Christian Preparatory School. Since being diagnosed,Singleton has completed six rounds of initial chemo and had a double mastectomy and reconstruction, followed by 25 rounds of radiation. She is currently cancer free but will still go in for maintenance chemo every three weeks for about a year. For another five to 10 years, she will take a chemo pill to help with recurrence.
“It’s not pleasant, the whole thing,” she said. “Your whole life is turned upside down when you lose every aspect of who you are and what you are.”
In addition to her family, a group of 15-20 of Singleton’s close friends known as “Margie’s Army” has been by her side, from keeping her company during treatments to holding fundraisers to help with all the expenses that come with fighting cancer.
But Singleton sees her journey with cancer as part of God’s plan. And that journey has fueled a desire to help other women in Georgia avoid the path she ended up on.
“It has empowered me to research and to help other women,” she said. “I’ve always want to help, anyway. But this has changed me a lot – it really has, I think for the positive. Now that I’m on the other side of it, I wouldn’t trade it for anything if I can just help one person to not have to go through this.”
With the help of Margie’s Army, Singleton hopes to pass legislation that would add Georgia to the list of 36 other states that require language on mammogram reports explaining breast density and the associated risks.
Her surgeon, Dr. Burak, said he agrees a mammogram report should better explain breast density.
“It mandates a conversation,” he said. “Also, it’s putting it in the patient’s hands – this (mammogram report) language – to say, ‘Hey, it’s your responsibility to talk to your doctor. We’re informing you that you have this issue.’ And the doctor gets the report, too, so it goes both ways. And I think it’s helpful for both people to be reminded.”
Singleton said Margie’s Army has been in contact with several legislators, including House Majority Leader Jon Burns, R-Newington; Rep. Bill Hitchens, R-Rincon; and Rep. Sharon Cooper, R-Marietta; and even Gov. Nathan Deal to pitch the importance of “Margie’s Law.”
And their efforts seem to be gaining traction.
Cooper, who chairs the House Health and Services Committee, said last week she’d been in contact with Burns and Hitchens about such a bill. While a bill isn’t likely to be introduced before next legislative session in January, she said she thinks it would get passed.
“I think we can get a bill that will let women with dense breast tissue know there is another option (for screenings) if they want to discuss it more with their physician,” Cooper said. “We’ll find a way, and I’m pretty sure we can get a bill passed.”
She said legislators are everyday citizens who may not know about an issue if they don’t hear about it from someone else.
“It’s people like Margie that can make a real difference because they bring these issues before us,” Cooper said. “It’s a great and wonderful goal, and I appreciate her coming to us.”