After a mammogram, you may be told that you have a dense breast. Dense breasts are normal and common, but what might they mean and do they need to be treated?
What is a dense breast?
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Whether or not you have dense breasts is not in your control. Dense breasts are not related to the appearance or feel of the breast, but rather to how the breast appears on an x-ray.
The breast consists of tissue such as fat that gives it its shape, as well as the glands and ducts that produce milk. Fat appears black on a mammogram; everything else appears white.
The measurement of breast density is not precise and is based on the judgment of the radiologist. Radiologists classify breasts into four types based on what they see on the x-ray.
- Most are fatty; these breasts have the least amount of fibrous tissue.
- Dispersed dense area type, where the breast is mostly fat, but some areas are dense.
- Unevenly dense type, mostly dense tissue with some areas of fat.
- Extremely dense type, with breasts containing almost no fatty tissue.
About half of women over age 40 have dense breasts and half have non-dense breasts, with most women falling into one of two intermediate types (scattered dense or unevenly dense). Only about 10% of women have mostly fatty or extremely dense breasts.
What causes it?
What causes it?
Factors that influence breast denseness include the following.
- Age: Breast density appears to be higher in younger women than in older women, although there are exceptions, and most women’s breast density decreases with age.
- Heredity: If the mother has dense breasts, the daughter may also fall into this category.
- Menopause: Most women have a relative increase in fat in their breasts after menopause.
- Hormones: Hormone replacement therapy and birth control pills can make breasts denser.
- Lactation: Dense breast tissue is associated with the production of milk, and breastfeeding can make breasts denser.
Is there an increased risk of cancer?
For early detection of breast cancer, it is recommended that all women, regardless of breast density, have a monthly self-exam, an annual mammogram by a doctor, and a mammogram every year starting at age 40.
Dense breasts appear to increase the risk of breast cancer. However, there is no consensus among experts on whether dense breasts alone mean that additional breast cancer screening is warranted. Other risk factors should be discussed with your doctor. If one is also at high risk because of one’s age, race, family history, or previous biopsy results, one should undergo more frequent screening or even undergo a different type of screening.
Challenges when getting a mammogram
Dense breasts can be difficult to identify on a mammogram. Tumors and masses can appear as white patches, as can dense tissue. Therefore, it is challenging to distinguish normal from suspicious lesions in this situation, and it is easy to miss lesions or misdiagnose normal tissue as breast cancer.
But this does not mean that you should stop getting mammograms. Even in women with dense breasts, swellings can be accurately identified in most cases, and new technology has made mammograms more accurate.
Mammograms may not be perfect, but they are still one of the best ways to detect breast cancer early.
Are there other screening methods?
The following tests can find cancers that may be missed with a traditional mammogram.
- Magnetic resonance imaging (MRI), which is often recommended by doctors if you are at high risk for breast cancer, as well as annual mammograms, uses a magnetic field to create images of the internal structures of the breast.
- Digital breast tomosynthesis (DBT), which is a special type of mammogram that takes pictures of the breast from different angles and then blends them into a three-dimensional image.
- Ultrasound, which uses ultrasound to obtain images of the internal structures of the breast.
- Breast-specific gamma imaging, also known as molecular breast imaging, involves injecting radioactive material into the bloodstream and then detecting it with a special camera. Differences occur in cancerous tissue compared to normal tissue.
The disadvantage of adding additional tests is that problems that are not cancer are usually found, which may lead to more tests or even surgery that would not otherwise be needed. Mammograms are the only type of breast screening that has been shown to save lives. Please discuss this with your doctor and work together to determine which tests are right for you.