— The Rough House Rundown: What I’ve Learned About Breast Cancer Screening —

About 70% of The Rough House community is made up of women. In recent years, it’s become increasingly clear how frustrating it can be to feel like your specific needs are treated as an afterthought—especially within a medical and fitness landscape that has historically been shaped through a male-dominated lens. Many health and performance studies have traditionally relied on male subjects, producing guidance that is then broadly applied to women despite significant biological differences. What works well for men doesn’t always translate to what works best for women. And thankfully, progress is being made as more female trailblazers in the wellness and medical fields bring these issues into the light. Voices like Dr. Stacy Sims have gained well-deserved attention for challenging this approach and emphasizing the importance of training, fueling, and recovering in ways that are designed specifically for women—not adapted from male-based models.

That, however, isn’t the sole focus of this newsletter. I’m not here to rehash everything that’s already been said, but rather to highlight a bigger truth: women are hungry for clear, trustworthy health answers more than ever before. The specific topic I want to focus on today is breast cancer screening—something I, as a man, admittedly never had much reason to think deeply about. But I’m now married to a woman and run a business where women make up the majority of our clientele, so it’s safe to say my interest in women’s health has grown exponentially in recent years.

After talking with Eve and then doing some independent research of my own, what I found was eye-opening—and honestly, too important not to share. While some of this may already be familiar to many, I have a strong hunch that it’s not something everyone is fully aware of—and it’s important enough that it should be. Being informed matters, especially when walking into doctor appointments or making decisions about your health.

My goal isn’t to alarm anyone—it’s to enlighten and empower you, and more importantly, help you advocate for yourself or someone you love. This topic matters enough that it inspired this newsletter and has me seriously considering making it a quarterly—or at least recurring—series. I know this edition is a bit longer, but I promise it’s worth the read given how important this information is.

Self-Advocacy

One theme that kept coming up in everything I read:
People who speak up, ask questions, and push for clarity often get diagnosed earlier and treated more effectively.

It turns out that relying solely on “routine screening,” or assuming a doctor will automatically tell you everything you need to know, isn’t always enough. I haven’t met anyone who embodies self-advocacy more than Eve. As some of you may know, Eve lives with an autoimmune disease, and when she was first diagnosed, the immediate recommendation was immunosuppressants and steroid injections. There was little to no conversation about nutrition and only minimal discussion around exercise. 

Thankfully, she didn’t jump straight into medication. Instead, she chose to explore a more holistic approach first—one piece of which was joining a gym (which, if you haven’t guessed already, is how we met). Eve was diagnosed at 24, and at the time she was told it wasn’t a matter of if she would need immunosuppressants, but when. Fast forward more than 13 years, and she’s no closer to that treatment path now than she was back then.

The reason isn’t luck—it’s advocacy. Eve took the time to ask questions, seek out additional information, and look at the bigger picture. She weighed what she learned on her own alongside medical guidance and ultimately made informed decisions about her health. That willingness to advocate for herself changed the trajectory of her care and her life.

To be clear, this isn’t about vilifying medication. In many cases, medication is absolutely necessary and can be life-changing—or even life-saving. Sometimes, despite best efforts, it’s the only path that brings real relief. The point here is simply that medication doesn’t always have to be the first or only option, and that exploring other approaches—or pairing them alongside medical treatment—can often make a meaningful difference.

What makes the biggest difference when advocating for yourself?

• Asking follow-up questions
• Requesting explanations you truly understand
• Getting second opinions when something doesn’t feel right
• Trusting your intuition about your body

If something feels off — say something.
If something feels unclear — ask something.

Your body is not an inconvenience. Medical professionals are here because people have health issues. You’re not annoying because you have issues. You’re human.

One of the Most Important — and Least Understood — Factors: Breast Density

Until recently, I had never heard of breast density—yet it turns out it’s a critically important factor in breast cancer detection. Many women are aware that breast density exists, but far fewer fully understand how much it can impact the effectiveness of a mammogram. Most people are given a breast density category on their mammogram report, yet many don’t realize it’s there—or what it actually means. After digging into this myself, here’s a clear breakdown:

Breast density is classified into four categories:

A. Fatty

B. Scattered Fibroglandular Tissue

C. Heterogeneously Dense

D. Extremely Dense

Why this matters:

• Dense breast tissue (categories C and D) makes it harder for a mammogram to detect cancer.
  On the imaging itself, dense tissue and tumors both appear white, meaning abnormalities can be hidden.
• Many people with dense breasts benefit from additional imaging like ultrasound, 3D mammography, or MRI. But these options aren’t always brought up unless the patient asks.
• Breast density also slightly increases cancer risk itself, which is even more reason to tailor screening.

Here’s the key takeaway I want you to remember:

If you have dense breasts (C or D), your screening plan may need to be more personalized and more thorough — not because something is wrong, but because mammograms alone may not tell the full story.

Check your mammogram results and talk to your doctor about whether additional imaging would benefit you.

Surgery and Treatment Options Are Not One-Size-Fits-All

Another thing I learned: breast cancer surgery isn’t a straightforward procedure. There are multiple paths, each with its own implications:

• Lumpectomy
• Mastectomy
• Nipple-sparing mastectomy
• Reconstruction (immediate or delayed)
• Implant-based or flap-based reconstruction
• Choosing no reconstruction at all

Your values matter in these decisions.
Your comfort level matters.
Your long-term goals matter.

A good surgical team will walk through every option with you — not just the standard/easier one.

If you or someone you love ever faces this situation, remember this:

You are allowed to ask about every option.
You are allowed to slow down and understand the trade-offs.
You are allowed to choose what aligns with your life, not just the textbook.

Some medical systems are built around efficiency, which can unfortunately mean rushed appointments and limited face time. But you are not just another billing code—you’re a human being discussing a potentially life-altering health concern. You deserve time, attention, and respect when speaking with a medical professional. If you consistently feel rushed, unheard, or treated like a number when addressing something this serious, it may be worth seeking a provider who takes the time to truly listen.

We Need to Talk More About What Happens After Treatment

Across survivor stories and medical literature, one message kept repeating:

Finishing treatment isn’t the end of the journey — it’s a major transition.

People often face:

• changes in identity
• shifts in body image
• fear of recurrence
• physical limitations (range of motion, pain, lymphedema risk)
• emotional and mental aftershocks once the crisis is “over”

Survivorship care — including imaging, physical therapy, mobility work, and mental-health support — is essential, not optional.

It’s also a reminder to check in on people after treatment ends.
Often, that’s when they need support the most.

Why I’m Sharing All This With You

As someone who runs a fitness studio, I spend a lot of time thinking about health, strength, and longevity. Working out is great, but there is more to health and wellness than deadlifts and push-ups. Many of you have spouses, partners, mothers, sisters, daughters, or friends who could benefit from this information. Many of you are those people.

So here’s what I hope you take away:

• Look at your breast density on your mammogram report.
• Don’t hesitate to ask your doctor if additional imaging is appropriate.
• Make a habit of asking questions and getting clarity.
• Encourage the people you love to do the same.
• And most importantly: trust yourself when something doesn’t feel right.
• If you encounter an arrogant doctor looking to move onto the next patient as fast as possible, don’t let them, or find a new doctor. You’re not returning a pair of pants, you’re talking about you life, health, and self-identity. Demand that those three things are respected.
• Don’t do kneeling pushups. They suck and there is almost no benefit to doing them that will help you eventually do them off your knees. Zero carryover. Elevate your upper body on steps or the Smith Machine. (Sorry, I just couldn’t help myself.)

If even one person reading this gets earlier detection, better information, or a clearer understanding of their body — then this email will have done its job.

Here are some additional resources:

• https://podcasts.apple.com/us/podcast/life-saving-intel-amandas-breast-cancer-surgeon-dr/id1564530722?i=1000732753112
• https://www.mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968
• https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/breast-density-and-your-mammogram-report.html

-Colin

January 26, 2026