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.
Age Of Relative At Diagnosis
The age of the affected relative at diagnosis also has an effect on the risk factor of breast cancer. A younger age at breast cancer diagnosis of a family member is associated with an increased risk for first-degree relatives.
The risk factor of breast cancer as the age of the first-degree relative at diagnosis increases.
So, for example, if the relative was diagnosed before they are 40 years old the breast cancer risk is three times higher. If the relative was 40 to 50 years of age at diagnosis the unaffected relative has twice the risk. This decreases to 1.5 times more likely if the first-degree relative was between 50 and 60 at diagnosis.
Furthermore, there is no or little increased risk if the relative is diagnosed after 65 years of age.
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 Should You Do If You Have Dense Breasts
What should women with dense breasts do about it? I tell all my patients the same thing, says Dr. Citrin. Make sure you get your annual screening mammograms and check your breasts on a regular basis. Be familiar with your breasts, particularly if you are pre-menopausal. If anything feels different, see your doctor right away. Additionally, if a woman knows she has dense breasts and, therefore, a slightly increased risk of breast cancer, she may want to consider alternative forms of imaging, such as an MRI.
Some evidence suggests that additional tests may help detect breast cancer in dense breast tissue. Supplemental tests for breast cancer screening may include:
- Digital breast tomosynthesis: This screening uses X-rays to take multiple images of the breast from several angles. The images are synthesized by a computer to form a 3-D image of the breast.
- Breast MRI: MRI uses magnets to create images of the breast.
- Breast ultrasound: Ultrasound uses sound waves to analyze tissue. A diagnostic ultrasound is commonly used to investigate areas of concern discovered on a mammogram.
- Miraluma breast imaging:This is a non-invasive nuclear medicine test that produces detailed images of malignant lesions in dense, fibrous breast tissue.
Who Reads My Mammogram To Determine If I Have Dense Breasts
After your mammogram, you will receive a written report with the radiologists findings. Radiologists are medical doctors who have completed a four-year residency in radiology and who specialize in diagnosing and treating conditions using medical imaging.
Breasts imaging specialists are radiologists who only read breast imaging exams. Early-stage cancers are more often detected by women who have their mammograms read by breast imaging specialists.
If your state doesnt require breast density to be included on a mammogram report, you can ask your radiologist to tell you your classification. With this information and your family history, your doctor can determine if you need more screening exams.
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Impact On Breast Cancer Risk
Dense breasts are associated with an increased risk of breast cancer.;And the denser a womanâs breasts are, the higher the risk of breast cancer. The reason for this association is not completely clear.
To give a sense of perspective about the increased risk of breast cancer with dense breasts:
- Oral contraceptives increase the risk of breast cancer in women 40 to 49 years old by 1.3 times
- Heterogeneously dense breasts increase the risk by 1.6
- Extremely dense breasts increase the risk by 2.04
- A first-degree relative with breast cancer diagnosed before age 40 increases the risk by 3.0
The Breast Cancer Surveillance Consortium Risk Calculator is a tool used to asses five- and 10-year breast cancer risk based on age, race/ethnicity, family history of breast cancer, history of a benign breast biopsy, and breast density. While part of this calculation, dense breasts are not the strongest risk factor.
A previous personal history of breast cancer, a family history of breast cancer, and having a genetic mutation associated with breast cancer are all bigger risk factors for breast cancer than dense breasts are.
How Is Breast Density Measured
When you have a mammogram, a radiologist reads the results using the Breast Imaging Reporting and Data System, or BI-RADS, published by the American College of Radiology. This is a standard system for reporting whats seen on the imaging.
BI-RADS uses an assessment scale from 1 through 6 to indicate whether there were no unusual findings or, if something was found, whether it was more likely benign or malignant . The report will also give a recommendation for routine screening or indicate what follow-up tests may be needed. An assessment of 0 means that additional imaging is first needed in order to characterize a potential finding.
In the BI-RADS report, the radiologist also includes a score for breast density on a scale from A through D:
A) Mostly fatty: The breasts are made up of mostly fatty tissue and contain very little fibrous and glandular tissue. About 10% of women have fatty breasts.
B) Scattered fibroglandular densities: The breasts are mostly fatty tissue, but there are a few areas of fibrous and glandular tissue visible on the mammogram. About 40% of women have scattered density.
C) Heterogeneously dense: A mammogram shows many areas of fibrous and glandular tissue. About 40% of women get this result.
D) Extremely dense: The breasts have large amounts of fibrous and glandular tissue. About 10% of women fall into this category.1
From left to right: BI-RADS categories A through D
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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.
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.
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Hormones: Menarche And Menopause
The age at which a young girl starts her periods and the age of menopause can both affect the risk of breast cancer.
A 2012collaborative study found that breast cancer risk increased by 1.050 for every year younger at menarche. The risk for every year older at menopause was less at 1.029.
In general, younger age of menarche and older age at menopause increases the risk of breast cancer due to prolonged hormone exposure.
How Are Dense Breasts Screened For Cancer
The latest mammogram technology is called 3D mammography or tomosynthesis. It allows the radiologist to view the breast in thin “slices” rather than as a whole. This improves the radiologists ability to detect breast cancer while also reducing and the number of false alarms. The 3D imaging is performed simultaneously with a 2D mammogram, so the length of the exam does not change. The patients experience is the same, too. She stands with her breast pressed against the imaging tool in a private screening area.
If you have dense breasts, you may want to consider getting an ultrasound as well for extra reassurance. Or, at least talk to your doctor about about the pros and cons of any additional testing, says Dr. Hooley.
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Dense Breast Tissue And Increased Risk Of Breast Cancer
For a woman, having dense breasts is associated with a higher risk of breast cancer. Only age and BRCA gene status carry a higher risk than dense breast tissue according to a 2015 medical study.
The density of your breast tissue shows up on a mammogram. Basically, dense breast tissue is made up of more glandular and fibrous tissue than fatty tissue. The dense breast tissue shows up aswhite on mammograms, like that of tumors.
The amount of breast density is expressed by the radiographer as a percentage. For women under 56 years with breast cancer, having a breast density of over 50% was three times more likely than in older women.
The risks for breast cancer in women with over 50% of dense breast tissue was 26%.
Recent medical studies have suggested that high percent mammographic density may be an inherited quality. However, breast density is also affected by age, certain drugs, pregnancy and menopause but can be changed. Furthermore, dense breast tissue makes screening less accurate.
According to the American Cancer Society, in general, higher per cent breast density has an increased risk of 1.2 to 2 times that of women with average breast density.
Does The Increase In Breast Density That Naturally Occurs While A Woman Is Breastfeeding Interfere With The Ability To Identify Abnormalities In The Breast
The accuracy of screening tests such as mammogram, ultrasound, and MRI is reduced during breastfeeding because changes in the breast during this period make cancers harder to detect. For routine screening, it is generally preferable to wait a few months after breastfeeding has stopped before having a mammogram or MRI.
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Here Are Answers To Common Questions About Dense Breast Tissue:
What is dense breast tissue?
Dense breast tissue refers to the appearance of breast tissue on a mammogram. Itâs a normal and common finding.
Breast tissue is composed of milk glands, milk ducts and supportive tissue. These elements make up the dense tissue in the breast. Breasts also include fatty tissue, which is nondense tissue. When viewed on a mammogram, women with dense breasts have more dense tissue than fatty tissue.
On a mammogram, nondense breast tissue appears dark and transparent. Dense breast tissue appears as a solid white area on a mammogram, which makes it difficult to see through.
How do doctors determine if you have dense breast tissue?
The radiologist who analyzes your mammogram determines the ratio of nondense tissue to dense tissue and assigns a level of breast density. Levels of density are described using a results reporting system called Breast Imaging Reporting and Data System, as provided by the American College of Radiology.
The levels of density are often recorded in your mammogram report using letters:
In general, women with breasts that are classified as heterogeneously dense or extremely dense levels C and D are considered to have dense breasts. About half of women undergoing mammograms have dense breasts.
What causes dense breast tissue?
Itâs not clear why some women have a lot of dense breast tissue and others do not. You may be more likely to have dense breasts if you:
Why does breast density matter?
Are other tests more effective?
Are There Any Tests That Are Better Than Mammography For Women With Dense Breasts
Mammography is the only screening test that has been proven to decrease deaths from breast cancer. However, mammography is not perfect and some cancers will not be seen on mammograms. For women with dense breasts, ultrasound is often used in addition to mammography for further evaluation. Ultrasound, however, picks up many things that turn out not to be cancer but that may require further testing, including biopsy.
Sometimes magnetic resonance imaging can detect a cancer in dense breasts that was not seen by mammograms or ultrasounds. However, MRIs also have drawbacks. They require the injection of intravenous contrast dye; like ultrasound they may give a false-positive reading, resulting in the need for additional testing or biopsy that turns out to be benign; and they are very expensive and not always covered by insurance. In general, MRIs are used in women at very high risk of breast cancer such as those with a known genetic mutation associated with the development of breast cancer. Every patient is different, and decisions about which type of screening test is advisable should be made after discussion with a doctor.
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The Importance Of Age And The Lifetime Risks For Breast Cancer
In 1989, a womans lifetime risks for breast cancer was about 1 in 10. That risk increased to about 1 in 7 by 2003 and is currently 1 in 8 in the US over an 80-year lifespan.
Even though it may seem that breast cancer risk has increased in recent years, the actual risk of dying from breast cancer has decreased significantly.
As we can see from the graph above, the likelihood of being diagnosed with breast cancer increases as a woman ages.
The percentages on the graph can also be translated to the following risks for breast cancer listed below:-
- Age 30: 1 in 227
- At age 40: 1 in 68
- Age 50: 1 in 42
- Age 60: 1 in 28
- At Age 70: 1 in 26
What jumps out at you from the above table is the exponential increase in probability between age 30 and 40 years.
A woman is around 3.5 times more likely to get breast cancer at age 40 than she was aged 30. In addition, between the ages of 40 and 50, there is another increase in probability.
Race And Ethnicity And Breast Cancer Risk
The risk of breast cancer incidence and mortality does vary according to different ethnic and racial groups. We can see the risk for each different racial group on our bar chart above.
In general, white women are more likely to develop breast cancer. However, there are many factors involved in breast cancer risk factors and race.
We have a whole new post on Incidence and Mortality Rates by Race.
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Will My Health Insurance Cover It
Nationwide recommendations do not advise women with dense breasts to have more frequent screenings. However, some states require that insurance cover more frequent breast cancer screenings for those with higher breast density.;
Women with dense breasts should talk to their doctor about other cancer risk factors and protective measures and work together to make a screening plan, Mandal says.
Essential information will be included in the mammogram report that goes to your doctor and the patient letter you receive giving you the results of your mammogram. This is mandated by state and federal laws.
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.
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How Does Yale Medicines Approach To Breast Cancer Screening Stand Out
Yale Medicine physicians are able to address all of your needs, from screenings and biopsies to treatments, in one placethe Breast Center. Our breast imaging doctors are recognized leaders in the field who conduct research in order to provide the best possible care for our patients, using the latest technology. By using 3-D mammography in tandem with 2-D mammography, we improve the detection of lesions and reduce false alarms to help patients get a more accurate diagnosis. Tomosynthesis is available at all our locations, except the mobile mammography service.