'The x-ray didn't pick it up': Bernie's breast cancer message

In December, the Albury psychologist had her first free mammogram and nothing of concern was raised.

But only a month later, she found a lump in her breast.

"I went to my doctor and he was concerned, and when they found it, it was early-stage breast cancer," she said.

"I had a lumpectomy, chemo and radiation and a thing called Herceptin, which is like the breast cancer wonder-drug.

"I'm on Tamoxifen for five or 10 years, and I'm on a trial drug for 12 months.

"When all the treatment was done I did go back to BreastScreen NSW to talk to the doctors about why they missed it, because I wanted to understand it."

Ms Hurley learned that for some women with denser breasts like herself, a mammogram may be less effective.

"For some women like me - because I have no fat in my breasts basically - the X-ray just doesn't pick it up," she said.

"They agreed that I would have been better off going for an ultrasound as well.

"I think for BreastScreen, just to get this message across to women to have mammograms is a big one, because they do save lives, but I just think there's a cohort of us who don't know they should be getting an ultrasound."

Dense breasts are common - more than half of women under the age of 50, and about one-third of women aged over 50 have dense breasts.

BreastScreen Australia released a position statement in 2016 recognising that in the future, breast density may have a role in determining the method and frequency of screening.

Their position is that no other screening methods are provided through the program, because these other technologies have not been proven to save additional lives.

"Mammography is the best breast cancer screening test in a population-based screening program for asymptomatic women aged 50-74, even those with dense breasts," the statement concludes.

BreastScreen NSW program manager Naomi Combe said the density of a woman's breasts had no relation to their size.

"Breasts are made up of fatty tissue and fibrous and glandular tissue - milk ducts, milk glands and supportive tissue," she said.

"Some women will have a higher ratio of fibrous and glandular tissue compared with fatty tissue.

"In a mammogram, fibrous and glandular tissue appears in white.

"Since some cancers also appear as white areas on mammograms, it may be harder to find some cancers in women with a high ratio of fibrous and glandular tissue.

"All BreastScreen NSW mammograms are reviewed by two radiologists.

"If a woman's screening mammogram is unclear, she may be called back for further tests, which may include an ultrasound.

"The NSW Government, through the Cancer Institute NSW, is investing $62.2 million in breast cancer screening this financial year."

A literature review published last year by Allen and Clarke for The Department of Health found a number of technologies, including automated whole breast ultrasound (ABUS), "are likely to be of interest to breast screening programs".

"ABUS is already in clinical use for breast cancer screening in the United States and Canada," researchers said.

"Many studies have found that using ABUS and FFDM [full-field digital mammography] leads to significantly higher cancer detection rates for women with denser breasts than using digital mammography alone.

"These may have a future in population screening, but it is too soon to determine the likelihood of this."

After a "big year", Ms Hurley is feeling good and is preparing to take part in the Melbourne Marathon Festival at the MCG next Sunday.

"I was booked in to do the marathon last year, and then when I got diagnosed I withdrew," she said.

"I've downgraded to a half-marathon ... but I still get to run around the 'G' with my Richmond guernsey on.

"I tried to stay active throughout my treatment, doing a few little runs.

"I did a park run in February and I thought I was flying, and I thought, 'I'm back!', but I was really slow, and that's when I thought 'I might need some help here'."

Ms Hurley reached out to Michelle Fletcher, owner of Zone Performance Coaching in South Albury.

"When Bern first reached out we had a conversation about her history, what her primary goal was and where she was positioned before she became unwell," Ms Fletcher said.

"She's full of energy and life, and we just hit it off."

Ms Fletcher has coached a number of cancer survivors.

"I don't think people fully understand what the treatment does to the body physiologically," she said.

"We've done a couple hard slogs, and for Bern it was like 'This is just another of those things I have to get through' - I knew she was a stayer.

"Your mental strength is so much more developed that little things just don't matter."

As resilient as Ms Hurley was, she said the experience of course took its toll.

"I would have said six months ago I was OK, but it's funny how far away from being OK you are," she said.

"It was like a hangover all the time - the [Albury Wodonga] cancer centre is fantastic, but I don't like going there," she said.

"The Herceptin was 17 shots - you're getting hooked up to that every three weeks for a few hours - and that was hard because you had to move your life around it

"Even though I knew it was good for me, it was tricky. I learned a bit about myself."

Next Sunday, Ms Hurley will begin her 21.1 kilometre race on the banks of the Yarra River in the city and come into a victory lap inside the MCG.

She'll be raising money for the Pain Revolution, which supports local health professionals to become pain experts in regional communities.

"One of my special interests as a psychologist is chronic pain, and there's a group of scientists, doctors, psychs and a lot of physios all over Australia who do volunteer work," Ms Hurley said.

"We teach health professionals and the public about contemporary pain science ... chronic pain can completely change a person's life.

"Pain Revolution is not-for-profit and we get a bit of funding through insurers, but not a lot, so we fundraise where we can."

But the biggest message for Ms Hurley is for women to regularly check their breasts and be aware of breast density.

"If I hadn't have been self-checking, it would have been a different outcome," she said.