D Mammography May Improve Detection
For women with dense breasts, an imaging exam called breast tomosynthesis, or 3D mammography, can help radiologists see cancers more clearly.
The experience of getting a 3D mammogram is essentially the same as conventional mammography from the patients point of view, but the machine gives the radiologist a more detailed look at the breast. 3D mammography does not create a true 3D image but produces multiple images, essentially dividing breast tissue into many thin slices.
With a stack of images, the radiologist can examine the breast layer by layer. Things that might be hidden in a standard two-dimensional image are uncovered in breast tomosynthesis, Friedlander says, and we find a few more breast cancers that way.
Formulate A Screening Plan With Your Doctor
Many states, including California, Virginia, and New York, require radiologists to tell you if your breasts are extremely dense.
While having dense breasts doesnt necessarily mean you will develop breast cancer, knowing you have dense breasts is a step toward health awareness. Ask your doctor to suggest a screening plan if you have dense breasts or other risk factors for breast cancer.
The United States Preventive Services Task Force recommends a mammogram every 2 years for those between 50 and 70 years old. Early screening or other diagnostic tests may be recommended from ages 40 to 49 depending on personal risk factors.
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 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.
How Are Dense Breasts Detected
When radiologists look at your mammogram, breast tissue will show up as black and white. Glandular and dense connective tissue will show up white on a mammogram because X-rays dont pass through as easily. This is why its called dense tissue.
X-rays pass through fatty tissue easier, so it shows up black and is considered less dense. You have dense breasts if your mammogram shows more white than black.
These tests are also used to help doctors diagnose potential breast cancer:
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Doctors Raise Awareness About Dense Tissue Concern During Breast Cancer Awareness Month
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This October, doctors are warning about the risks of breast cancer. Many women could be at a greater risk and not even know it.
Doctors are concerned about women with dense breast tissue. Women who have dense breast tissue have more supportive tissue than fatty tissue in their breasts. It’s detected with a mammogram.
This affects half of women, including Katie Couric, who spoke publicly about her diagnosis a few weeks ago. Women with dense breast tissue are two times more likely to get breast cancer.
Dr. Shakeeb Ahmad of Northwest Radiology said there are two reasons why dense breast tissue can be concerning. The denser breast tissue a woman has, the greater the risk for breast cancer. Also, when doctors look at the mammogram X-ray, dense tissue shows up white, and so does cancer, making it difficult to detect.
“When you have a breast cancer that shows up white on a background of non-dense breast tissue, it’s easy to see, versus if you have dense breast tissue, here you have white everywhere, now you’re trying to look for cancer that is white, it’s very hard to see,” Ahmad said.
It’s unclear why dense breast tissue leads to cancer.
Breast cancer is most common in your 40s, and African American women are at a greater risk.
Home screenings are also important periodically.
Demographically Speaking Are There Certain Populations With Higher Incidences Of Breast Cancer Or More Aggressive Forms Of It And If So How Does That Increased Propensity Impact The Guidance Associated With Screening For These Populations
Yes, actually, very much so. Black women are truly disproportionately hurt by any recommendations that do not recommend screening beginning at age 40. Black women are diagnosed at younger ages than white women. In fact, 23% of breast cancer in Black women is diagnosed in the decade of 40 to 50, whereas only 16%, which is still a large number, but not at not as large as for Black women, get breast cancer diagnosed between 40 to 50. So if Black women are not offered screening mammography at the age of 40, we will miss the chance for an early detection in many of these women.
It’s also very important to offer Black women yearly mammography and not mammography every other year because they have a propensity to get a more aggressive breast cancer called a triple-negative breast cancer. And that breast cancer can metastasize more quickly, it’s more aggressive. Just like with younger women, we have that shorter window where we want to catch that breast cancer in order to offer the benefits of early detection
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Your Healthy Family: Dense Breast Tissue And Breast Cancer
COLORADO SPRINGS In this Your Healthy Family, as part of Breast Cancer Awareness Month, we’re talking about dense breast tissue and the challenges it presents to catching breast cancer early. Its a topic that got national attention in recent weeks when Katie Couric announced she had been diagnosed with breast cancer.
I sat down with Dr. Olga Mengin, a board certified radiologist and the medical director of breast imaging for UCHealth Memorial in Colorado Springs who is also fellowship trained in breast imaging, to talk about the challenges dense breast tissue presents.
Dr. Mengin says, First I’d like to talk about Katie Couric. Whenever we have a celebrity that brings a personal story that people can associate with, it’s wonderful because it brings an awareness. I think it also helps people feel more comfortable with the whole process. It makes it easier for people to talk about, and that is good. I for one am extremely grateful to her for sharing this extremely personal story with everyone because we all benefit from it. I’m sure there’s women out there getting screening mammograms because of her story. Katie Couric talks about getting screening mammograms she is wonderful. She follows all our guidelines. She gets a mammogram every year and she also has dense breast tissue, so she gets some additional screening.
So how exactly does dense breast tissue make finding lumps more difficult – both for women doing a self-exam and medical professionals?
Can I Change My Breast Density
No breast density is determined by genetics, age, menopause status and family history. Weight gain and certain medications can also influence your breast density.
Though your breast density cant be changed, information is power. Being aware of your breast density classification can help you and your doctor make informed choices about your care.
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What Causes Extremely Dense Breast Tissue
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.
Why Additional Screenings Matter
Because people with dense breast tissue may have a harder time getting diagnosed with cancer early, it’s important that these people get additional screenings, as Couric suggested.
This is typically done with magnetic resonance imaging or with an ultrasound. An ultrasoundwhich was used to diagnose Couric’s canceris also the most commonly used, said Dr. Leung. Though it can sometimes deliver false positive results, it does a good job of finding cancer for people with dense breast tissue.
“Ultrasound is sound waves, as opposed to a mammogram, is X-rays,” Dr. Leung said. Unlike the mammogram, on an ultrasound it’s easier for doctors to tell tissue and tumors apart.
“The cancer looks dark, but the tissue looks relatively bright,” she said. “That’s actually a good thing for detection.”
But other screening tests are not in place of a mammogramthey’re in addition to it. The mammogram is critical to breast cancer diagnosis and will tell a doctor if a person has dense breasts and needs additional screening in the first place, Dr. Pinsky explained.
These screening tests should happen once yearly as soon as a woman with an average risk of breast cancer turns 40, according to the American College of Radiology and Society of Breast Imaging.
The American Cancer Society suggests the same, recommending yearly mammograms from ages 40 to 54. After that, mammograms can be done every other year. That cadence will likely hold, regardless of breast density.
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What Should I Do If I Have Dense Breast Tissue
If your mammogram report says that you have dense breast tissue, talk with your health care provider about what this means for you. Be sure that your doctor or nurse knows if theres anything in your medical history that increases your risk for breast cancer. To learn more about breast cancer risk factors, see Breast Cancer Risk and Prevention.
Any woman whos already in a high-risk group should have an MRI along with her yearly mammogram. To learn more about if youre in a higher-risk group for breast cancer, see American Cancer Society Recommendations for the Early Detection of Breast Cancer.
Recommendations On How To Inform Women
Physicians who counsel women about their respective choices regarding breast cancer screening in general, and screening in women with extremely dense breasts in particular, must have expertise in the principles of screening in general, and in screening by imaging in particular.
Such expertise is usually not routinely available in primary healthcare providers.
Accordingly, EUSOBI urges radiologists to assume this important task and directly engage in informing women about the pros and cons of screening. Educating other healthcare providers might be another way to ensure that women receive correct and objective information. The following passages may serve as a guide for womens education
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Is There An Increased Risk Of Breast Cancer If I Have Dense Breast Tissue
There may be a slightly increased risk for breast cancer if you have dense breast tissue. Healthcare professionals have not yet been able to prove why that is. Having dense tissue can also make it harder for radiologists to see breast cancer because it can be hidden by the similar appearing dense tissue.
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.
Click to see larger diagrams of the front viewimage icon and side viewimage icon of the breast, showing the parts of the breast.
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Finding Out Breast Cancer Coverage With An Existing Policy
When the Affordable Care Act was passed in 2010, it required that insurance plans cover 10 essential health benefits. Those benefits included the services needed to treat serious conditions like cancer.
Screening mammograms were made free, and ambulatory care , hospital care, laboratory tests, prescription drug coverage , and rehabilitation services were included in all plans.
Unfortunately, not all health plans have to follow the ACA rules. Individual private plans and small group plans do. However, plans that existed before the ACA and large-group plans do not. Depending on the type of insurance you have, your cancer coverage may vary.
What To Do If You Have Dense Breasts
According to Dr. Johnson, dense breast tissue is not something you can get rid of, and she also explains that not everyone who has it will develop cancer. It is advised that patients who are at risk and those who are above the age of 40 get their routine mammograms. Since breast density has the capability to obscure tumors, mammogram centers are now obligated by an FDA proposal to inform patients of their findings.
Knowing if you have a higher mammographic density is important, as Dr. Johnson advises being proactive and making an appointment with your provider to talk about a plan of action. “Know your family history, talk to your primary physicians about additional imaging,” she says. This is especially important, given the higher risk associated with interval cancers.
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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.
Extra Screening With Mri
Breast MRI takes screening one step further and is more sensitive, detecting even more cancers than ultrasound.
A breast MRI is more time-consuming and requires an intravenous injection of a contrast agent, which comes with a small risk of an allergic reaction. And as with ultrasound, patients screened with MRI are more likely to need biopsies for benign lumps.
For these reasons, we are careful about who we bring in for breast MRI, Friedlander says. We do not use it for average-risk women who have dense breasts but reserve it for women who are in a higher risk category.
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Dense Breasts Eclipse All Other Known Breast Cancer Risk Factors
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Women whose breasts are composed largely of glandular tissue, rather than fat, have an amplified risk of breast cancer, which exceeds the impact of other widely known risks on a population level, including family history of the disease, personal history of benign lesions and first full-term pregnancy over age 30.
In what is believed to be the first large-scale study to quantify the development of breast cancer according to the degree of glandular tissue , researchers headed by UC San Francisco evaluated risk factors in more than 200,000 women. The participants were aged between 40 and 74 and were enrolled in the Breast Cancer Surveillance Consortium, a research initiative designed to assess the delivery and quality of breast cancer screening. Approximately 18,000 of the women had varying stages of breast cancer, while around 184,000 did not.
Breast density, or degree of glandular tissue, was reported for each woman according to the four categories established by the American College of Radiologys Breast Imaging Reporting and Data System . These comprise: category A, breasts composed almost entirely of fat category B, those with scattered dense tissue but mostly fat category C, those with moderately dense tissue and category D, those in which dense tissue makes up at least 75 percent of the breast.
The findings were published in the journal JAMA Oncology on Feb. 2.
What Should I Do If I Have Dense Breasts
Talk to your doctor about your personal risk of getting breast cancer. Dense breasts are just one of several risk factors for breast cancer. Your doctor will also think about other factors, like your age and family history of cancer.
Different tests may be able to find some cancers that are missed on a mammogram. But these tests are more likely to have a false positive result . False positive test results often lead to unnecessary tests, like a biopsy. Also, you may have to pay for these tests.
Your doctor may suggest one of these tests
- Breast ultrasound. A machine that uses sound waves to make pictures, called sonograms, of areas inside the breast.
- Breast magnetic resonance imaging . A kind of body scan that uses a magnet linked to a computer. The MRI scan makes detailed pictures of areas inside the breast.
Talk with your doctor about how often you should be screened for breast cancer and which tests your doctor recommends.
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