You have probably heard breast density brought up at some point in your life, but do you know what it means? Read on to learn more, and be sure to ask your health provider, “Do I have dense breasts?”
WHO HAS DENSE BREASTS?
About 42% of all women have dense breasts. Generally, the younger you are the denser your breasts are; however, this is not always true! We’ve seen women as old as 95 that have dense breasts.
WHAT IS DENSE BREAST TISSUE?
Each patient’s breast tissue varies in density. The images below range from only fatty tissue to extremely dense tissue. Dense breast tissue appears white on mammograms. As you can see on the image on the far right, the mammogram is almost all white. This is what is called an extremely dense breast. Dense or extremely dense breast tissue makes it difficult for the Radiologist that is reading your mammogram to see small cancers under or within the dense tissue.
WHAT DOES THIS MEAN?
Studies have demonstrated that mammography misses every other cancer in women with dense breast tissue! That is 42% of the women – half of the cancers they have cannot be seen on mammogram!
HOW DO I KNOW IF I HAVE DENSE BREASTS?
When you have a mammogram, you will get a letter with the results of your mammogram. This will either be handed to you in the office or mailed to you after the mammogram is read. This is called your patient lay letter. If you have dense breasts, your patient lay letter will have a paragraph that says something like the following paragraph (the language varies somewhat for each state):
“Your mammogram indicates that you may have dense breast tissue. Dense breast tissue is relatively common and is found in more than forty percent (40%) of women. The presence of dense tissue may make it more difficult to detect abnormalities in the breast and may be associated with an increased risk of breast cancer. We are providing this information to raise your awareness of this important factor and to encourage you to talk with your physician about this and other breast cancer risk factors. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”
WHAT SHOULD I DO IF I HAVE DENSE BREAST TISSUE?
When you speak with your physician about the results of your mammogram, they will normally offer you multiple options:
1 – Whole Breast Ultrasound: Normally, this is done by a machine that is automated that can scan one breast at time. This procedure takes anywhere from 5-15 minutes per breast (depending on the type of machine they are using). Most insurances will pay for the exam if ordered by a physician. Statistics show that an additional 40% of cancers not seen on mammogram are seen with whole breast ultrasound.
2 – Breast MRI: This scan takes about 30 minutes for the complete exam and you lay on your stomach for the procedure. You are generally injected with gadolinium during the procedure. Anyone that has anything metal in their body (pacemaker, metal hip replacement devices, etc.) cannot have MRI. Also, this is not always paid for by insurance. Statistics show that an additional 50-60% of cancers not seen on mammogram are seen with MRI.
3 – Breast tomosynthesis (3D mammography): this type of study is helpful to a degree for women with dense breasts and has been shown to increase detection by 1-5% above 2D mammograms for women with dense breasts. Most insurance companies will pay for this exam. Statistically, up to about 10% of cancers not seen on 2D mammography are seen on 3D mammography.
4 – Contrast enhanced mammography: the patient is injected with iodine and then has a mammogram performed. This is not widely available, but most of the manufacturers of the mammography equipment are developing this capability. Most insurances will pay for at least a portion of this procedure. I have not found any statistics on the effectiveness of conventional 2D imaging vs contrast enhanced mammography.