DENSE BREAST DISCLOSURE WILL BE REQUIRED, according to new United States Food and Drug Administration (F.D.A.) rules. The agency wants to ensure that healthcare providers inform women that some breast anomalies require special attention. Today, I want to explore the risks of dense breasts, including their incidence, implications, and what you might consider doing if you have dense breasts.
“Absence is a house so vast that inside you will pass through its walls and hang pictures on the air.”
― Pablo Neruda
What are dense breasts?
Dense breasts refer to a mammographic finding, meaning that the breast tissue appears to have more glandular or fibrous relative to fatty tissue.
The breast comprises two types of tissue: glandular tissue, which produces milk, and fatty tissue, which provides support and cushioning. Dense breasts have more glandular and fibrous tissue and less fatty tissue, which makes them appear denser on a mammogram.
American College of Radiology experts classify breast density into four categories:
- Almost entirely fatty: The breast is composed almost entirely of fatty tissue and is the easiest to read on a mammogram.
- Scattered areas of fibroglandular density: There are some areas of glandular and fibrous tissue, but the breast is still considered primarily fatty.
- Heterogeneously dense: There are many glandular and fibrous tissue areas, and the breast is considered moderately dense.
- Extremely dense: This means there is a lot of glandular and fibrous tissue, and the breast is considered very dense.
Having dense breasts is common, not a disease or a condition. However, dense breasts may increase the risk of breast cancer and make it more difficult to detect small tumors on a mammogram. If you have dense breasts, your doctor may recommend additional screening tests, such as ultrasound or M.R.I., in addition to mammography.
Incidence
Dense breasts are quite common among women. About 40% of women who undergo mammograms have dense breasts. However, the percentage of women with dense breasts can vary based on age and menopausal status.
For example, younger women are more likely to have dense breasts than older women. Approximately 50 to 60 percent of women ages 40 to 44 have dense breasts. This range compares with 20 to 30 percent for women 70 to 74.
Additionally, women who use hormone replacement therapy (H.R.T.) may have denser breasts than those who do not.
It’s important to note that having dense breasts is not a cause for alarm, but it may require additional screening tests to ensure breast cancer is detected as early as possible. Women with dense breasts should speak with their healthcare provider to discuss their risk factors and appropriate screening recommendations.
Here are the percentages of women in each breast density category:
- A: Almost entirely fatty. About 1 in 10 women has this result.
- B: Scattered areas of fibroglandular density. About 4 in 10 women have this result.
- C: Heterogeneously dense. About 4 in 10 women have this result.
- D: Extremely dense. About 1 in 10 women has this result.
The updated Food and Drug Administration regulations require that patients be told that their breasts are dense or not dense; levels A and B would be “not dense,” while C and D are “dense.”
What causes dense breast tissue? Does it matter?
It’s unclear 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:
- Are younger. Your breast tissue tends to become less dense as you age, though some women may have dense breast tissue at any age.
- Have a lower body mass index. Women with less body fat are more likely to have more dense breast tissue than women who are obese.
- Take hormone therapy for menopause. Women who take combination hormone therapy to relieve signs and symptoms of menopause are more likely to have dense breasts.
Does it matter to have dense breasts?
First, women with dense breasts are more likely to get breast cancer. The denser your breasts, the higher your breast cancer risk. Scientists do not know why this is true.
Women with dense breasts are up to four to five times more likely to get breast cancer than women with fatty breasts.
Second, breast cancer patients with dense breasts are not more likely to die from breast cancer than patients with non-dense (fatty) breasts.
Third, dense breast tissue can conceal cancers. Fibrous and glandular tissue looks white on a mammogram. So can cancer. Because it’s hard to distinguish between a tumor and dense breast tissue on a mammogram, the radiologist may miss a small tumor.
My take — Dense breasts
Here are some tips for those who have dense breasts:
- Talk with your healthcare provider about your risk of getting breast cancer. Dense breasts are one cancer risk factor, but several others include inherited genetics (family history), age at first menstrual period, menopause age, alcohol, tobacco, number of full-term pregnancies, and more.
- Consider tests that have a higher sensitivity to picking up breast cancer. Unfortunately, tests such as M.R.I. are more likely to have a false positive result (the test is reported as abnormal, but you don’t have cancer). A false positive test result often leads to unnecessary tests, such as a biopsy.
Your doctor may suggest one of these tests —
- Breast ultrasound. A machine uses sound waves to create pictures (sonograms) of areas inside the breast.
- Breast magnetic resonance imaging (M.R.I.). This sophisticated scan uses a magnet linked to a computer. The M.R.I. scan makes remarkably detailed pictures of areas inside the breast but requires intravenous contrast.
Final thoughts
Please talk with your healthcare provider about how often you should have breast cancer screening and which tests she recommends. I’ll end with the take of Fred Hutchinson Cancer Center (Seattle, U.S.A.) researcher Dr. Christophe Lee. Speaking to the New York Times, he offers that “an initial finding of breast density should not reflexively lead to more tests.”
He continues:
“It can be confusing for women to know what the next step should be,” he added. “There is some evidence from Europe that women in the top 10 percent of density could benefit from supplemental M.R.I. screening.” But, he adds, “there is not much evidence that women outside of the extremely dense category would benefit from supplemental screening.”
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
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