Understanding Screening for Dense Breasts
- Breast density is a radiographic diagnosis that can only be determined with mammography. However, when it comes to testing women with dense breasts for cancer, mammography may need to be used with other screening methods.
- Dr. Linda Pak, a breast cancer surgeon at NYU Langone’s Perlmutter Cancer Center, recommends patients with dense breasts get ultrasound screenings in addition to mammograms.
- Beyond genetics, dense breasts, experience with radiation therapy, and menstruation at an early age (before 12) can put women into a high-risk category.
- If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Dr. Linda Pak, a breast cancer surgeon/oncologist at NYU Langone's Perlmutter Cancer Center and clinical assistant professor of surgery at NYU Grossman School of Medicine, suggests patients with dense breasts get ultrasound screenings in addition to mammograms for the best results.
Read MoreDr. Connie Lehman explains what dense breasts are.
In regards to additional testing recommendations, like a breast MRI, Dr. Pak suggested they “need to be made on an individualized basis and in consideration of a patient's other risk factors for breast cancer, such as a family history of breast cancer, known genetic mutation carrier status, or a personal history of high-risk lesions of previous breast biopsies.”
“Breast MRI is very sensitive but may also detect abnormalities that lead to additional workup but are not cancer. Thus the discussion and decision for any additional screening beyond an annual mammogram and ultrasound needs to be done on a patient-to-patient basis,” she said.
Dr. Pak recommends women with dense breasts and no other risk factors for breast cancer get an annual mammogram and ultrasound screening starting at age 40.
However, breast cancer screenings for patients under 40 will be determined by the type of breast cancer risk factors women have, she explained.
It’s also important to note that breast density can decrease as a woman gets older and gains weight or change as a result of certain hormonal medications, according to Dr. Pak.
Combining a Mammogram With An Ultrasound For More Accurate Results
“When it comes to dense breast tissue, I would describe it as if you are looking outside the scene or views of your yard through a very foggy glass. So then naturally, because it’s overlapping fibers you see less clearly,” Dr. Yuan Yuan, MD, an oncologist affiliated with the City of Hope Comprehensive Cancer Center in Duarte, California, said in an interview with SurvivorNet. “So in order to overcome that issue, for dense breasts, a mammogram is insufficient because sensitivity goes down.”
RELATED: 5 Things People Get Wrong About Breast Cancer
Dr. Yuan appeared to mirror Dr. Pak’s take on the screening for breast cancer, saying a mammogram often needs to be combined with an ultrasound and sometimes even an MRI for more accurate results.
She suggests women need to pay attention to their mammograms whether it be a traditional mammogram or a 3D tomography mammogram, which has better sensitivity noting that usually, “radiologists would always comment on that.”
“There’s a line that says dense breast tissue will potentially reduce sensitivity if needed, please discuss with a care provider,” Dr. Yuan, who works in the area of Southern California, explained.
Dr. Yuan said she sees a lot of women with dense breasts where she works due to the surrounding Asian population as people with this ethnic background tend to have dense breasts.
Understanding Breast Cancer
Breast cancer is a common cancer that has been the subject of much research. Many women develop this disease every year and men can develop this cancer too though it is more rare, in part, due to the simple fact that they have less breast tissue.
There are many treatment options for people with this disease, but treatment depends greatly on the specifics of each case. Identifying these specifics means looking into whether the cancerous cells have certain receptors. These receptors the estrogen receptor, the progesterone receptor, and the HER2 receptor can help identify the unique features of the cancer and help personalize treatment.
"These receptors, I like to imagine them like little hands on the outside of the cell, they can grab hold of what we call ligands, and these ligands are essentially the hormones that may be circulating in the bloodstream that can then be pulled into this cancer cell and used as a fertilizer, as growth support for the cells," Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, previously told SurvivorNet.
The Unique Features of Breast Cancer: Deciding the Right Course of Treatment
One example of a type of ligand that can stimulate a cancer cell is the hormone estrogen, hence why an estrogen receptor positive breast cancer will grow when stimulated by estrogen. For these cases, your doctor may offer treatment that specifically targets the estrogen receptor. But for HER2 positive breast cancers, therapies that uniquely target the HER2 receptor may be the most beneficial.
Symptoms of Breast Cancer
Signs and symptoms of the disease can include the following:
- A breast lump or thickening that feels different from the surrounding tissue
- Change in the size, shape or appearance of a breast
- Changes to the skin over the breast, such as dimpling
- A newly inverted nipple
- Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
- Redness or pitting of the skin over your breast, like the skin of an orange
It's important to keep an eye out for these symptoms while remembering that having one or many of them does not necessarily mean you have breast cancer. Regardless, you should always speak with a doctor promptly if anything ever feels off or you're experiencing one or more of the signs listed above. You never know when speaking up about your health can lead to a very important diagnosis.
Breast Cancer Screening
Screening for breast cancer is typically done via mammogram, which looks for lumps in the breast tissue and signs of cancer. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
For screening purposes, a woman is considered to be at average risk if she doesn't have a personal history of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase risk of breast cancer such as a BRCA gene mutation or a medical history including chest radiation therapy before the age of 30. Beyond genetics, family history and experience with radiation therapy, experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
When Should I Get a Mammogram?
In a previous interview with SurvivorNet, Dr. Connie Lehman, chief of the Breast Imaging Division at Massachusetts General Hospital, said people who hadn't reached menopause yet should prioritize getting a mammogram every year.
"We know that cancers grow more rapidly in our younger patients, and having that annual mammogram can be lifesaving," Dr. Lehman said. "After menopause, it may be perfectly acceptable to reduce that frequency to every two years. But what I'm most concerned about is the women who haven't been in for a mammogram for two, three or four years, those women that have never had a mammogram. We all agree regular screening mammography saves lives."
It's also important to be on top of self breast exams. If you ever feel a lump in your breast, you should be vigilant and speak with your doctor right away. Voicing your concerns as soon as you have them can lead to earlier cancer detection which, in turn, can lead to better outcomes.
When You're Getting a Mammogram, Ask About Dense Breasts
As previously discussed, dense breasts can sometimes make cancer more difficult to detect. Unfortunately, there's no way to determine if you have dense breasts just by feeling them only a mammogram can determine if you have it. Bestselling author and breast cancer survivor Laura Morton learned a really important lesson about advocating for herself when she was getting a mammogram and questioned her radiologist about dense breasts. The radiologist brushed her off.
Survivors Encourage Women to Ask Their Doctors About Dense Breasts
"I waited until afterward to mention to her how I felt about her response to what is a really important question, you can not feel if you have dense breasts. You have to be told if you have dense breasts," Laura says. "…So when somebody walks through your door and says, 'Do I have dense breasts?' Answer their question, don't roll your eyes and make them feel small for asking something that we are entitled to know."
Asking doctors questions like, "Do I have dense breasts?" or "Do I need to consider getting a 3D mammogram?" really can save lives. So ask, ask, ask!
Understanding Your Risk
The risk of developing breast cancer varies greatly from person to person, so it's important to discuss your specific risk level with your doctor. That being said, there are some important risk factors to keep in mind.
Major Reduction in Cancer Risk by Following Old Standbys Diet and Exercise
In a previous interview with SurvivorNet, Dr. Elizabeth Comen laid out several risk factors for breast cancer including:
- Being a woman: Women are at a higher risk for breast cancer, though men can get the disease too.
- Age: "Breast cancer becomes increasingly more common as women age," Dr. Comen said.
- Family history: "Some people think that breast cancer is only inherited through genes on the mom's side,” Dr. Comen said. "But it can also be related to genetic mutations that could be found on the father's side."
- Having had a prior biopsy on an abnormal area: "There are different markers, that if a woman has had a biopsy, it's important that she talk to her doctor about whether those markers are lending themselves to an increased risk of breast cancer," Dr. Comen said. If you've had a biopsy that indicated atypical hyperplasia, for example, you are at an increased risk of breast cancer. Atypical hyperplasia isn't cancer, but it is a precancerous condition that describes an accumulation of abnormal cells in the milk ducts and lobules of the breast.
- Radiation exposure: Cancer survivors who've had radiation to their chest are at an increased risk of breast cancer.
- Lifetime estrogen exposure: "About 2/3 of breast cancer are driven by the hormone estrogen," Dr. Comen said. "So, that means if a woman has had her period at an early age and started to go through puberty at an early age, at seven, eight, nine, and potentially a later age of menopause, means that her lifetime of having had menstrual periods and being exposed to higher levels of estrogen is higher, and therefore her risk of breast cancer is slightly higher."
- Not having a child before age 30 or never having children
- Obesity
- Drinking alcohol
- Lack of exercise: "While there's more research to be done in this area, it looks like if a woman is not exercising, she may also increase her risk for breast cancer," Dr. Comen said.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
