Defining Dense Breasts and How to Care for Them
Dense breasts are fairly common. In fact, slightly more women have them than don’t. Still, many women are confused about what it means to have dense breasts and how this may affect cancer screenings.
Breasts are made up of milk-producing glands, ducts that carry the milk; fibrous or glandular tissue; and fat tissue. Breasts are considered dense if there is more fibrous or glandular tissue and less fat tissue.
It is important to know which women have dense breast tissue for two reasons:
- Women with dense breasts are at slightly higher risk for breast cancer than women with less dense breasts, though the reason for this is not clear.
- Dense breasts can mask cancer on a mammogram.
Breast Density and Mammograms
Breast density is not discovered through physical examination. Rather it is determined by radiologic findings during mammograms. These imaging tests are an effective tool to screen for breast cancer early, before a lump can be felt.
Breast cancer is the most commonly diagnosed cancer in women in the US and the second leading cause of cancer death in women. Dense breasts are best screened with a 3D mammogram because fibrous and glandular tissue – found more abundantly in dense breasts – looks white on a mammogram. This “whiteout” can be problematic for screening, as it can be harder to see small tumors as opposed to ones that show up more clearly against the black background of breasts with more abundant fatty tissue.
I recommend 3D mammography (also known as DBT, digital breast tomosynthesis) for all my patients. This technology – which is available at Holy Name’s Breast Center – was approved in 2017. It provides a clearer picture than standard 2D imaging, resulting in fewer recalls for additional testing. The same amount of radiation – a very low dose – is used for both types of tests, well within the FDA safety standards for mammography.
Often a follow-up breast ultrasound is recommended for women with dense breasts. Your doctor can prescribe both a mammogram and breast ultrasound at the same time. MRIs are sometimes also advised for women with dense breasts. However, because health insurance plans do not always reimburse for screening breast MRIs, an ultrasound is usually suggested as the first follow-up test. If suspicious tissue or a tumor is found, a biopsy will be recommended.
Your Personal Mammogram Schedule
Regular screening mammography is recommended starting at age 40 along with a follow-up with your doctor to discuss results, especially if you have dense breasts. Your doctor will prescribe the best screening schedule and tests for you. It’s helpful to know your personal and family history regarding breast cancer. Speak with your doctor regularly to assess your breast cancer risk during your annual physical exam or gynecologic check-up. Finally, be aware of what your breast tissue normally feels like, and if anything has changed, call your physician or other healthcare provider for advice.
Dense Breasts after Menopause
Breast density decreases with age and menopause. A woman’s healthcare provider may suggest that mammograms can be reduced to once every two years past age 55, according to guidelines set by the American College of Obstetricians and Gynecologists and the American Cancer Society.
Hazel A. Brana-Leon, MD, is an obstetrician-gynecologist who sees patients in her office at 222 Cedar Lane, Teaneck. She is board-certified by the American Board of Obstetrics and Gynecology, fluent in Tagalog, and conversant in Spanish. To make an appointment with her: Call 201-836-4025.
The Breast Center at Holy Name, located on the main campus at 718 Teaneck Road in Teaneck, is certified by the American College of Radiology. The center offers the latest generation screening and diagnostic technology within a warm space that focuses on patient care, safety and privacy. Board-certified radiologists, registered nurses and female breast imaging technologists offer comprehensive services. Call 201-833-7100 to schedule a mammogram.