What Factors Are Associated With Dense Breasts
Several factors play a role in determining breast density, including:
- Age. Women under 50 tend to have higher breast density than older women. In particular, breast density often declines after menopause, but older women, however, can still have dense breasts.
- Genetic factors. Evidence suggests that breast density is associated with genetic factors that can be inherited.
- Having given birth. Giving birth is associated with lower breast density.
- Tamoxifen. Use of tamoxifen, a medication that may be used to treat or prevent certain breast cancers, can lower breast density.
- Hormone replacement therapy . Use of HRT after menopause is associated with higher breast density.
- Body mass index . Women with lower BMIs tend to have higher density breast tissue.
Other Steps You Can Take
If you have dense breasts, there are other steps you can take to care for your breast health. In addition to working with your doctor to consider supplemental screening, you can:
Make sure you have a mammogram every 12 months without delay, and try to go to a center with 3D mammography if possible.
Perform breast self-exams so that youre aware of any changes in your breasts, which should be reported to your doctor.
Follow all of the lifestyle recommendations for reducing breast cancer risk, such as:
My Mammogram Results Say I Have Dense Breast Tissue Am I Normal
Dont panic. Dense breast tissue is not cancer. The results are merely informing you that, like 40 percent of American women, your breast tissue is particularly fibrous. This does, however, make it more difficult for a mammogram to see through the entire breast. Dr. Kirtly Parker Jones explains dense breasts in further detail and what alternative screening methods might work the best for you.
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How Can I Be Sure I Dont Have Cancer
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What Is Mammographic Density
Mammographic density is a term used to describe how breasts look on a mammogram. It measures and compares the different types of breast tissue that are seen on a mammogram. It cannot be seen or felt in a clinical examination by a doctor.
The types of tissue that make up the breast and can be seen on a mammogram are:
- glandular tissue
- connective tissue .
On a mammogram, fatty tissue appears as dark, while glandular and connective tissue appear white. Breasts that have a lot of glandular and connective tissue are described as dense. The expression having dense breasts is used to refer to women who have high mammographic density.
Cancers also appear as white on a mammogram.
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Dense Breasts Are Normal
So if you got the letter saying that your breasts were dense, don’t freak out. You are normal. If you’re at high risk for breast cancer, talk with your doctor and maybe another imaging technique would be right for you. And you can check out the website areyoudense.org and that can explain a little, and you can celebrate the fact that you still have young breasts. At least on mammogram.
Increased Risk For Cancer
Some studies have shown that women with extremely dense breasts have a four to six times greater risk of developing breast cancer than those with mostly fatty breasts.
Cancer appears to develop in areas where the breast is dense. This suggests a causative relationship. The exact connection is unknown, though.
A 2018 study found that dense breasts were associated with larger tumor diameter and more lymph node-positive disease than non-dense breasts.
Research also suggests that dense breasts have more ducts and glands. This increases risk because cancer often arises in these places. Researchers are still studying this theory.
Dense breasts dont affect other outcomes, such as survival rates or response to treatment. However, suggested that women with dense breasts who are considered to have obesity or have tumors at least 2 centimeters in size have a lower breast cancer survival rate.
Keep in mind that having dense breasts doesnt necessarily mean you have breast cancer.
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How Is Dense Breast Tissue Diagnosed
Dense breast tissue is diagnosed during a mammogram. A radiologist is a physician who reads X-rays, including mammograms. She/he will describe your breast density based on how your tissue looks on your mammogram. The dense glandular tissue will look white, and fatty tissue will look dark on your mammogram. The more white areas the radiologist sees on the image, the denser the breast.
Does Dense Breast Tissue Raise Your Risk Of Breast Cancer
People with dense breasts have a higher risk of breast cancer. People with the highest density are 4 to 6 times more likely to get breast cancer than people with the least dense breasts. This is because glandular tissue is more likely to develop cancer. However, even people with breasts that are mostly fatty can get breast cancer.
Having dense breasts also makes it harder to see signs of cancer on a mammogram. The dense tissue looks white on the image, so it can hide lumps that are cancer. Its harder to find cancer in dense breasts early, when its easier to treat.
To learn more about the risk factors for breast cancer, please see MSKs breast cancer screening guidelines.
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Cancer Screening For Women With Dense Breasts
Mammograms don’t always reveal cancers that may be present in dense breasts. Small cancers can be hidden by dense tissue, since both appear white on a mammogram. The more density there is, the harder it is for a radiologist to see an abnormality. Know your breast density and make it part of a conversation with your doctor about your annual screening plan.
Newer technology known as digital breast tomosynthesis , sometimes called three-dimensional mammography, appears to be more accurate than traditional 2D mammography for women with heterogeneously dense breasts. Like traditional mammography, 3D mammography takes two views of each breast, but then creates images of thin slices of the breast tissue for the radiologist to read. These slices are somewhat like a CT scan result, showing slivers of the breast with the overlying tissue peeled away. This can allow the radiologist to see lesions hidden within the tissue and better characterize their appearance. Check to see if your imaging center offers 3D mammography, and if not, ask your doctor if you can switch to one that does.
Most states still do not require insurance coverage for supplemental screening however, these tests will likely be covered if ordered by a health provider. DenseBreast-info.org maintains a map of legislation by U.S. state and also has information for people in Europe. Talk to your doctor to see what he or she recommends if youre concerned about breast density.
The most common options are:
What Screening Is Recommended For Women With Dense Breasts
Mammograms remain the recommended screening tool, despite the potential for some small cancers to be missed. Many cancers can be seen on a mammogram, even if you have dense breasts. There is currently not enough evidence to include additional screening modalities in the clinical guidelines. Clinical trials are being undertaken to look at adding other screening such as ultrasound and MRI.
However, anyone with very high mammographic density and other risk factors should discuss supplementary screening options such as ultrasound or MRI with their doctor.
If you are concerned, you should talk to your GP or breast surgeon about what is best for you.
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Should Women Who Have Dense Breasts Undergo Supplementary Screening Tests
Though supplementary screening tests can detect cancers that are missed by conventional mammography, not all experts recommend that every woman diagnosed with dense breasts undergo additional screening tests. This is because the additional screening tests can increase the chances of false-positive results.
A false-positive result occurs when a screening test identifies something in the breast that may be cancer, but which upon further investigation turns out to be non-cancerous. False-positive results can cause substantial stress and anxiety. Whats more, women need to undergo additional testing to determine if the finding is cancer or a false-positive.
Women with dense breasts should talk to their doctor about the benefits and risks of supplementary screening tests, in particular if they have other risk factors for breast cancer.
How Is Breast Density Categorized
Doctors use the Breast Imaging Reporting and Data System, called BI-RADS, to group different types of breast density. This system, developed by the American College of Radiology, helps doctors to interpret and report back mammogram findings. Doctors who review mammograms are called radiologists. BI-RADS classifies breast density into four categories, as follows:
- Almost entirely fatty breast tissue, found in about 10% of women
- Scattered areas of dense glandular tissue and fibrous connective tissue found in about 40% of women
- Heterogeneously dense breast tissue with many areas of glandular tissue and fibrous connective tissue, found in about 40% of women
- Extremely dense breast tissue, found in about 10% of women
If you are told that you have dense breasts, it means that you have either heterogeneously dense or extremely dense breasts.
The four breast density categories are shown in this image. Breasts can be almost entirely fatty , have scattered areas of dense fibroglandular breast tissue , have many areas of glandular and connective tissue , or be extremely dense . Breasts are classified as âdenseâ if they fall in the heterogeneously dense or extremely dense categories.
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What Are Some Of The Drawbacks To These Different Tests
Many people have anxiety about getting a mammogram because the breast is compressed during the examination. We do this to reduce its thickness and use less radiation to get a good picture. At some of UChicago Medicines mammogram testing sites, we have a newer technology with smart curve paddles and that technology greatly reduces the compression associated with a mammogram.
Annual Screenings Are Important
Allison Gleason, RT , an OSF HealthCare supervisor of mammography and ultrasound, said its important to remember that the density of a womans breasts can change over time. Thats why its important to get annual mammogram screenings to stay up-to-date on the condition of your breasts. Remember to continue to getting routine screening mammograms even when additional exams are suggested for you.
Breast tissue consists of fatty and fibroglandular tissue. Dense breast tissue is defined as having a higher percentage of fibroglandular tissue within your breasts. If more than 50% of your breasts is made of fibroglandular tissue, then your breasts are classified as dense.
The more fibrous and glandular tissue absorbs more radiation during mammography, reducing the accuracy of the test and making it more difficult to properly diagnose breast cancer. Dense breast tissue shows up white on a mammogram, as do tumors, which makes it more difficult to identify the difference.
According to the American Congress of Obstetricians and Gynecologists, a mammogram will identify 88% of cancers in a breast that is almost entirely fat, or low in density. Thats compared to 62% in high-density breasts.
What Are Some Common Tests To Measure Fibroglandular Density
Youll need a mammogram to show your fibroglandular density. Depending on what kind of breast tissue you have, more advanced imaging technologies may be necessary to spot cancer cells.
- A low-dose X-ray captures an image of the inside of your breasts.
- 3D mammography. A low-dose X-ray captures several images of your breasts from multiple angles. These images are compiled to create a 3D image of your breasts. This allows better visualization in dense tissue because it decreases the phenomenon of overlapping breast tissue.
- Breast ultrasound. Sound waves capture an image of your breast tissue and project them onto a screen.
- Breast MRI.Magnets and radio waves record structures inside your breast and project those images onto a screen.
- Molecular Breast Imaging . A tracer is injected into a vein in your arm and flows throughout your body. A special camera records the tracers interaction with tissues in your body. These interactions show up on screen and look different depending on whether the tracer interacts with cancerous vs. non-cancerous tissue.
Talk to your provider about which screening options theyd recommend based on your risks. Double-check with our insurer to see what imaging procedures are covered.
Mammographic Density And Other Oncogenic Signaling
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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If I Have Dense Breasts Do I Still Need A Mammogram
Yes. Most breast cancers can be seen on a mammogram even in women who have dense breast tissue, so its still important to get regular mammograms. Mammograms can help save womens lives.
Even if you have a normal mammogram report, you should know how your breasts normally look and feel. Anytime theres a change, you should report it to a health care provider right away.
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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How Can I Increase My Breast Size
No food or diet plan has been clinically proven to increase breast size. There are also no supplements, pumps, or creams that can make breasts larger. The best natural way to enhance the look of your breasts is to do exercises that strengthen the chest, back, and shoulder area. Good posture also helps.
What Are The Parts Of The Breast
A womans breast has three kinds of tissue
- Fibrous tissue holds the breast tissue in place.
- Glandular tissue is the part of the breast that makes milk, called the lobes. The tubes that carry milk to the nipple are called ducts. Together, fibrous and glandular tissue are called fibroglandular tissue.
- Fatty tissue fills the space between the fibrous tissue, lobes, and ducts. It gives the breasts their size and shape.
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Detecting Breast Cancer: Thin Vs Dense Breast Tissue
Of course there’s also skin on the top of the breast, and the nipples and their blood vessels, and lymph glands, but they don’t really count in the mammogram business. With the traditional mammogram, x-rays go easily through fat tissue but don’t go through fibrous tissue very well, and don’t go through cancer very well. So fibrous tissue and ductal tissue looks white on a mammogram, and so does cancer. When a woman is young, under 50, or premenopausal, the breasts are more dense according to the mammogram. When you get older, the breasts become mostly fat and are easy to see through.
When a breast is easy to see through, it’s easier to detect cancers. When the breast is dense, it’s harder to see the little cancers. Now, dense breast tissue is common. About two-thirds of premenopausal women have dense breasts, and about a quarter of postmenopausal women. Put the two together, and about 40% of women have dense breasts. Postmenopausal women on hormone replacement therapy tend to have denser breasts.
When my patients were worried about the term dense breasts, I just told them that they had youthful breasts. Which is always nice to hear, but it made it harder for mammograms to see through the entire breast.
Mammographic Density As An Independent Risk Factor For Breast Cancer
The presence of dense breast tissue greatly and independently increases the risk for developing breast cancer . Wolfe was the first researcher to observe and publish the association between the presence of dense breast tissue and the occurrence of breast cancer . Since then, several studies have confirmed this positive correlation between MD and the risk of developing breast cancer . In a large meta-analysis conducted by McCormack and colleagues which compared percent density and breast cancer incidence, the combined relative risk of breast cancer was 1.79 , 2.11 , 2.92 , and 4.64 for MD categories 524% , 2549% , 5074% , and75% , respectively. These data suggest that there is a strong positive association between the increase in MD and the increased risk for breast cancer. Additionally, Boyd and researchers have speculated that because of this strong association, out of all the breast cancer cases reported, one-third could be linked to the existence of highly dense breast tissue . However, the underlying mechanisms of the positive association between MD and the risk of breast cancer remain to be elucidated.
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