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Are Dense Breasts More Prone To Cancer

Should You Worry About Dense Breast Tissue

MRIs of dense breasts find more cancer, false positives

Breasts come in different shapes, sizes and densities.

In some cases, dense breast tissue can be associated with an increased risk of breast cancer.

A 2017 U.S. study revealed that four in 10 cases of breast cancer in younger women can be blamed on high breast density. The results show that breast density is a much more important breast cancer risk factor to be aware of than a persons family history. But having dense breasts is not an abnormal condition. In the United States, 43% of women over the age of 40 have dense breast tissue. Its basically a physical attribute of the body and theres little anyone can do to actively change or improve the density of their breast.

Is There A Risk In Having Dense Breasts

Having dense breasts isn’t as big a risk factor as inheriting a genetic mutation like BRCA1 or BRCA2, but it’s not insignificant: Studies show that if you have heterogeneously dense breasts, you’re 1.62 times more likely than average to develop breast cancer. If your breasts are extremely dense, you’re 2.04 times as likely to develop breast cancer. That’s pretty similar to the increased risk conferred by having one first-degree relative with breast cancer , according to an article published in July 2017 in the journal Medical Clinics of North America. And research published September 2017 in the journal JAMA Oncology showed that dense breasts increase your risk of cancer more than other known risk factors, such as post-menopausal weight gain or a first pregnancy after age 35.

Dense breasts probably increase the risk of cancer, at least in part, because the glands that make up dense tissue tend to contain cells that frequently divide. Genetic mistakes, or mutations, are more likely to occur during cell division, so dividing more frequently gives these cells more of a chance to turn cancerous.

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What Screenings Or Types Of Mammograms Do You Recommend To Women With Dense Breasts

Women with dense breasts should seek out tomosynthesis, also called 3D mammography. 3D mammograms have been shown to detect more instances of breast cancer in women with dense breast tissue . Sometimes these women may still need additional screening, including another mammogram or a screening breast ultrasound. Screening breast ultrasound, performed in conjunction with mammography , has been shown to detect more breast cancers than mammography alone, but they also have an increased rate of false positives. This may result in a recommended six-month follow-up appointment or a benign breast biopsy .

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Breast Density May Be Leading Indicator Of Cancer Risk

— Women whose breasts are predominantly made up of more dense, glandular tissue face higher odds for breast cancer, a new study finds.

The researchers added that, based on their study of 200,000 women, breast density may be the most important gauge of breast cancer risk, eclipsing family history of the disease and other risk factors.

“The most significant finding in this study is the impact of breast density on development of breast cancer in the population,” said study senior author Dr. Karla Kerlikowske. She is a researcher in the department of epidemiology and biostatistics at the University of California, San Francisco .

Still, not everyone is convinced that breast tissue density is the preeminent risk factor for breast cancer.

Dr. Kristin Byrne is chief of breast imaging at Lenox Hill Hospital in New York City. She believes that the numbers in the study attributed to risk based on tissue density seem “incredibly high, especially when other risk factors were not taken into consideration.”

As the UCSF researchers explained, glandular tissue appears dense on a standard mammogram, while fatty tissue is less so. And many factors can influence the composition of breast tissue.

Overweight or obese women typically “have lower breast density, though age is a strong determinant of breast density as well,” study first author Natalie Engmann, a Ph.D. candidate in UCSF’s department of epidemiology and biostatistics, said in a university news release.

More information

Mammographic Density And Other Oncogenic Signaling

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Expression of Ki-67, a cell proliferation marker, in high versus low density tissue remains controversial, with few studies suggesting no association, while one study suggested higher Ki-67 in stroma of high versus low density tissue . The authors that found a correlation of tissue density with Ki-67 also reported a decrease in CD44, a TGF- target and an increase in cyclooxygenase-2 in the stroma of high versus low density breast tissue . These authors concluded that TGF- repression elevated the expression of COX-2 and Ki-67 in women with high versus low-density breast tissue , providing some evidence of why women with high-density breast tissue are at risk of developing breast cancer. Of note is that COX-2 over-expression is clearly associated with invasive breast cancers and ductal carcinoma in situ, but its association with dense tissue has not been fully investigated .

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What Does Having Dense Breasts Do To A Womans Risk For Breast Cancer

If you compare the 10 percent of women who have extremely dense breasts with the 10 percent of women who have very little breast density, the risk for breast cancer is higher in those with very dense breasts.

However, most women fall somewhere in between in terms of breast density, so its nearly impossible to determine whether a particular womans breast density is a risk factor for the disease.

Should Women Who Do Not Have Dense Breasts Make Any Changes To Their Regular Screenings

Women who do not have dense breasts may still develop breast cancer, and should continue to receive regular mammograms. Regular mammography is the only screening method that has been shown to decrease deaths from breast cancer, and all women of appropriate age should have mammograms, regardless of their breast density.

Memorial Sloan Kettering provides comprehensive, individualized breast cancer screening services that include mammography, ultrasound, and MRI, at our Evelyn H. Lauder Breast Center.

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D Mammography Breast Ultrasound And Breast Mri

Some data suggest 3D mammography may find more breast cancers in women with dense breasts compared to 2D mammography .

Breast ultrasound and breast MRI are being studied to learn whether they improve detection in women with dense breasts compared to mammography alone .

More research is needed to understand the benefits and harms of using these imaging tests for women with dense breasts .

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.

Characteristics Of Dense Breasts

What Are Dense Breasts?

Breasts are composed of fibrous, glandular, and fatty tissue. A woman’s breasts are considered dense if they have less fat and more glandular and fibrous tissue than average.

There are four categories used to describe breast density:

  • Breasts that are the least dense have almost all fatty tissue
  • Breasts that have scattered areas of fibroglandular density
  • Breasts with heterogeneous density
  • Breasts that have almost all glandular and fibrous tissue with little to no fatty tissue.
  • Dense breasts are more common among women who are young and postmenopausal women who take hormone therapy for symptoms of menopause.

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    How Common Are Dense Breasts

    Nearly half of all women age 40 and older who get mammograms are found to have dense breasts. Breast density is often inherited, but other factors can influence it. Factors associated with lower breast density include increasing age, having children, and using tamoxifen. Factors associated with higher breast density include using postmenopausal hormone replacement therapy and having a low body mass index.

    What Does It Mean To Have Dense Breasts

    What does it mean to have dense breasts? Dr. Temeika Fairley explains in this video.

    A mammogram shows how dense your breasts are. When you get the results of your mammogram, you may also be told if your breasts have low or high density. Women with dense breasts have a higher risk of getting breast cancer.

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    Many Women With Dense Breasts May Not Need Additional Screening

    Although dense breast tissue, which appears white on mammograms, can mask the presence of tumors, a new study suggests that having dense breasts alone may not be a reason for additional screening.

    Women with dense breasts are at increased risk of breast cancer, and high breast density is a cause of false-negative results on a standard screening mammography. However, results from a new study suggest that breast density alone should not dictate whether women should receive additional screening for breast cancer after a normal result on a screening mammogram.

    Rather, the NCI-supported study found, for women with dense breasts, a screening strategy that also takes into account other risk factors is the best predictor of developing a breast cancer after a negative mammogram and before their next mammogram, often referred to as an interval cancer.

    We found that for the vast majority of women undergoing mammographyincluding those with dense breasts but low 5-year breast cancer riskthe chance of developing breast cancer within 12 months of a normal mammogram was low, the studys lead investigator, Karla Kerlikowske, M.D., of the University of California, San Francisco, said.

    Similar federal legislation is currently being considered by Congress. Although these additional imaging procedures can detect cancers missed by mammography, their use has also been found to increase false-positive results and to lead to additional procedures, including unnecessary biopsies.

    Does Breast Size Affect Your Risk Of Breast Cancer

    Automated Breast Ultrasound

    Women with overly large breasts often have concerns about how their breast size may be affecting their health. In addition to issues like back pain, poor posture, and skin irritation, some women wonder if having a fuller bust creates a higher chance of getting breast cancer. Several studies have been conducted over the years to evaluate a possible link between breast size and breast cancerdoes having larger breasts make you more prone to tumors?

    A direct link between breast size and breast cancer has not been found. While there is some overlap of genetic factors that lead to breast growth and breast cancer, how these factors interact is unknown. A more important question is not breast size, but rather breast content. The Centers for Disease Control and Prevention reports that having dense breast tissue is a risk factor for breast cancer. This is because dense breasts tend to have more connective tissue than fatty tissue, which can sometimes complicate the process of identifying tumors in mammograms. As a result, the CDC says women with dense breasts are more prone to getting breast cancer.

    In addition to dense breast tissue, other risk factors for breast cancer include obesity, a family history, alcohol consumption, and older age. While some of these factors cannot be controlled, there are certain lifestyle habits that can reduce the risk of breast cancer, such as being physically active and limiting alcohol.

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    About Author: Lisa Coon

    Lisa Coon is a Writing Coordinator for OSF HealthCare, where she has worked since August 2016. A Peoria native, she is a graduate of Bradley University with a degree in journalism. Previously, she worked as a reporter and editor at several newspapers in Iowa and Illinois.She lives in Groveland with her husband and son. In her free time she likes to cook, bake and read. She freely admits that reality TV is a weakness, and she lives by the quote, The beach is good for the soul.

    Dense Breasts And Breast Cancer Risk

    Breast cancer is the second-most common cancer affecting American women. In fact, 1 in 8 women receives a breast cancer diagnosis in her lifetime. To protect your health, preventive care is important.

    Women over 45 and those with a family history of breast cancer should get mammogram screenings regularly. Mammograms are one of the best ways to detect early signs of breast cancer, when its most treatable.

    But if youve had a mammogram and were told that you have dense breasts, you might be wondering what that means for your health. Our OB/GYN team at The Womens Center can help you understand your risk of breast cancer.

    Dense breast tissue often makes mammogram screenings less effective, because the tissue is hard to see through. But does having dense breasts mean youre more likely to develop breast cancer?

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    How To Find Out If You Have Dense Breasts

    In the United States, 37 states and Washington, D.C., require breast imaging centers to give women some level of information about breast density after their mammogram. In 2019, the U.S. Food and Drug Administration began to develop a single national reporting standard imaging centers can use to notify both the woman and her doctor about her breast density. However, this hasnt yet been implemented.4

    Federal law requires that all women receive a letter notifying them about the results of their mammogram. In most states, this form letter now also tells you if you have dense breasts, and, in some states, your specific density category. However, the content of the letter varies widely by state and may not include specific details about your situation. Most of the letters will advise you to discuss your results with your doctor. Your breast density is also included in the final mammography report to your healthcare provider, prepared by the radiologist who read the images. If you live outside the United States, you may or may not be notified about your breast density, depending on the regulations in your country. DenseBreast-info.org is a good resource for finding out what the laws are where you live.

    Having dense breasts isnt your fault, and it isnt something you can control. Breast density is thought to be inherited in part, although the amount of dense breast tissue you have can change over time. Breast density can decrease as you go through menopause.

    Whats The Best Way To Screen Dense Breasts

    Dense Breasts or Breast Cancer?

    When it comes to finding the most breast cancers, thereâs no question MRI is king.

    MRI, or magnetic resonance imaging, is one of the most effective tools around for finding breast tumors, even those growing in dense tissue which is notoriously hard to image. Dense tissue masks cancer on mammograms much like a snowstorm can mask a snowball â or a polar bear. Both appear white.

    The problem is MRIs come with a royal price tag, making them far too costly to use as a preliminary screening tool for every woman with dense breasts. Thatâs nearly half of women in the U.S.

    But what about a shorter, more streamlined version of MRI? Could that be a better, more affordable way to screen average-risk women with dense breasts?

    Researchers from the large cancer research group ECOG-ACRIN tried to answer that question with a trial, just , that pitted the most sensitive type of mammogram available, digital breast tomosynthesis , against a faster, more targeted version of magnetic resonance imaging dubbed “abbreviated breast MRI,” or AB-MRI. Both types of MRIs use an injected contrast agent to light up the cancer.

    The good news? AB-MRI is extremely effective at catching breast cancers. The bad news: nobody knows what to bill for it so thereâs no way to tell if itâs more cost-effective than 3D mammography.

    Not yet, anyway.

    What could this mean for women?

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    What Affects Breast Density

    High breast density is common. In the U.S., 40-50 percent of women ages 40-74 have dense breasts .

    Breast density varies greatly by age and weight. Dense breasts are more common in both young women and thin women :

    • About 50-60 percent of women ages 40-44 have dense breasts, compared to 20-30 percent of women ages 70-74.
    • About 50-60 percent of women with a healthy weight have dense breasts, compared to 20-30 percent of obese women.

    Medications that contain hormones can also affect breast density. For example :

    • Women who take menopausal hormone therapy tend to have denser breasts than they would if they didnt take MHT. As women age, their breasts become less dense and more fatty. Taking MHT slows this process. MHT is also called postmenopausal hormone use and hormone replacement therapy .
    • Women who take the drug tamoxifen tend to have lower breast density than they would if they didnt take tamoxifen.

    How To Decrease Breast Density To Reduce Breast Cancer Risk

    If you have been told after a mammogram, ultrasound or MRI that you have increased breast density, listen up. Increased breast density, as detected through these screening techniques, is a strong known risk factor for breast cancer.

    So what does it mean? Breast tissue is composed of fat, glandular and connective tissue. Fat is less dense and appears dark on a mammogram, while glandular and connective tissues are more dense and appear light. When more glandular and connective tissue are present, breast density is greater.

    And heres the rub. The risk of breast cancer is four to five times greater in women who have increased density in more than 75% of their breast tissue, than in women with little or no density in the breast. One third of all breast cancers are found in women who have increased breast density in over 50% of their breast tissue.

    The good news breast density can diminish over time. However, women whose breast density does not diminish over time are more likely to be diagnosed with breast cancer. Ill explain how to reduce breast density shortly.

    One study showed that women who had been diagnosed with breast cancer and who were able to decrease their percent density by 10%, had a 55% decreased risk of breast cancer in the opposite breast, relative to women who had little or no change in density from baseline to first follow-up mammogram.

    Ways of Assessing Breast Density

    Mammographic Grading System for Breast Density

    BI-RADS 2: 26-50% Dense Breast Tissue

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