Things I Wish My Doctor Knew

Register to hear Nikki read her story live at our upcoming Perkatory event on April 9th at 7pm ET.

I do not write this to assign blame. I write it because I survived — and survival has given me clarity.

There are things I wish my doctor knew.

I wish my doctor knew how to calculate my breast cancer risk accurately. With a first-degree sister diagnosed premenopausally at 38, over a decade of oral contraceptive use, and extremely dense breast tissue, my lifetime risk was not abstract—it was measurable. Using validated models such as Tyrer-Cuzick, my risk would have exceeded the 20% threshold that qualifies for annual breast MRI screening years before my diagnosis.

Instead, one afternoon in April 2025, when I asked about getting a breast MRI, my risk was documented as 16.6%. I do not know which calculator was used. I only know what that number did—it removed urgency. It placed me in the gray zone. It delayed escalation.

Risk matters. Twenty percent is not just a number. It is the difference between “routine” and “high-risk.” It is the difference between annual mammography alone and supplemental MRI. It is the difference between reassurance and vigilance.

I wish my doctor knew that for women like me—dense breasts, significant family history, hormonal risk factors—mammography alone is often not enough.

Extremely dense breast tissue both increases breast cancer risk and decreases the sensitivity of mammography. That is not theoretical. That is physiology. Dense tissue can mask malignancy. When the test is not sensitive enough, repeating it without escalation does not create safety—it creates false reassurance.

There were other tools available. Breast MRI. Contrast-enhanced mammography. Emerging technologies such as dedicated breast CT. No, not all are universally accessible. Yes, insurance barriers exist. But access to care is not simply about what is offered automatically—it is about what is pursued.

I wish my doctor had felt empowered to push harder. To order the MRI. To fight the denial. To conduct the peer-to-peer review. To file the appeal. To document the risk and insist on coverage. Referring me to a high-risk clinic was not wrong—but it was not urgent. And urgency matters when cancer is involved.

If I had been placed on the recommended algorithm—alternating MRI and mammography every six months—my cancer might have been caught as DCIS, stage zero. Instead, I was diagnosed at stage I. I am grateful it was not worse. But gratitude and grief can coexist. Earlier was possible.

I also wish my doctor knew that I would have traveled. I would have gone out of network. I would have paid out of pocket. I would have flown to New York or Dallas or anywhere necessary if someone had said clearly, “Your mammogram is not sensitive enough for your breast density. You need additional imaging.”

Clarity saves lives. Ambiguity delays action.

The letter said I had dense breasts. It suggested I “consider” discussing supplemental screening. That is not the same as a direct call to action. Patients do not live inside radiology reports. They live inside busy, complicated lives. “Consider discussing” is not the same as “This test cannot reliably rule out cancer in your breast tissue. You need another one.”

I wish my doctor knew that language matters.

I also wish my doctor knew what I looked like beneath the white coat.

I appeared healthy. Fit. Educated. A radiology resident. But I was under immense pressure—family expectations, professional scrutiny, societal demands. I was navigating stress that manifested physically: night sweats, migraines, brain fog, worsening endometriosis. My body was signaling that something was wrong. I came to my providers asking for help.

As a Black woman, I do not complain easily. Many of us do not. We are conditioned to endure. To push through. To be strong. When we finally say, “Something is wrong,” it is rarely casual. It is usually after we have exhausted ourselves.

When Black women are diagnosed with breast cancer at higher rates and at later stages, we must ask why. We must examine access, bias, communication gaps, and systemic inertia. “Protect Black women” cannot remain a slogan—it must become clinical practice.

If I come to you and say something feels off, please do not dismiss it because I look accomplished or resilient. I did not become a first-generation physician from Detroit by being fragile. I became one by working two or three times harder to occupy rooms not built for me. When I finally say I cannot carry something alone anymore, it deserves attention.

What I wish my doctor knew most is how profoundly this changed my life.

Breast cancer did not just interrupt a year. It altered my trajectory. It reshaped my plans for fertility and motherhood. It disrupted my residency training and board preparation. It introduced surgeries, scars, and decisions I was not prepared to make so young.

Yes, I am grateful it was stage I. Yes, I am fortunate to be here. But I was also the exception. I am a radiology resident. I understand imaging. I knew how to read reports. I knew the algorithms. I am in the top fraction of medical literacy in this country—and I still had to find my own cancer.

If it required that level of knowledge and persistence for me, what chance does the average patient have?

Early detection should not depend on insider knowledge. It should not require medical training, privilege, or relentless self-advocacy. It should be systematic, clear, and equitable.

I wish my doctor knew that numbers are not abstract. That density is not a footnote. That risk models must be applied carefully. That appeals are worth the effort. That clear language changes outcomes. That cultural context matters. That when a high-achieving Black woman says she is unwell, it may have taken everything in her to say it.

Most of all, I wish my doctor knew that this story is not just about me.

It is about every woman whose dense breast tissue is quietly masking disease. Every patient placed just below an arbitrary threshold. Every letter written in technical language instead of plain truth. Every provider who hesitates to challenge an insurance denial. Every Black woman who waits too long to insist she deserves to be heard.

Things I wish my doctor knew are not accusations. They are lessons paid for with scar tissue.

And if we are willing to listen—to the data, to our patients, to the disparities—we can ensure that fewer women have to learn these lessons the way I did.