Don’t Be Dense about Dense Breasts

African american woman examing her breast

Not all breasts are created equal. Girls learn this at puberty, and women re-learn it all the time, thanks to a popular culture seemingly fixated on breasts and breast size. But from a health perspective, breast size or outward appearance is much less important than something you cannot readily see: breast density.

Studies show that women who have dense breasts have a higher risk of breast cancer. And at the same time, because of the density of breast tissue, that cancer may be more difficult to spot on a routine mammogram.

So what exactly are dense breasts, and why should you be concerned about whether yours are dense or not? Roper St. Francis Healthcare radiologist Dr. Vicky Nguyen gives some pointers.

What’s the definition of dense breasts, and are there any symptoms?
Dr. Nguyen: Breast density is used to compare the relative amount of fibroglandular tissue compared to the amount of fatty tissue in a woman’s breasts on a mammogram. Approximately 50% of women have “dense breasts,” which means the majority their breast is composed of fibroglandular tissue. There are no specific symptoms associated with having dense breasts. The only way you’d know is if you get a letter after a mammogram (state law mandates this) in which the level of breast density is assigned by the radiologist who interpreted your mammogram.

Why should we be concerned about dense breasts?
Dr. Nguyen: It can be more difficult to detect cancer in women with dense breasts because the fibroglandular tissue can potentially mask the finding. Studies have found that there is an increased risk of breast cancer for women with dense breasts.

If I get a letter saying I have dense breasts, what should I do?
Dr. Nguyen: Talk with your doctor, and he/she will discuss your risk factors and tailor a breast screening plan that is appropriate for your situation. This may include doing additional screening tests, including mammography with tomosynthesis (3-D), MRI, ultrasound, and molecular imaging.

What’s your basic message to all women, and is it different if they have dense breasts?
Dr. Nguyen: A screening mammogram is recommended every year for women starting at age 40. Screening mammograms remain an effective tool in detecting breast cancer in all women with any level of breast density. It is the only modality proven to reduce mortality from breast cancer. Tomosynthesis is widely available and can be performed at the same time as the screening mammogram to help evaluate dense tissue and reduce the number of patients called back for additional testing. It is also important to have prior mammograms available for comparison to help radiologists detect slowly developing cancers.