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What You Need to Know About the Dense Breast Issue

With new research and legislation, women are learning what dense breast tissue means for breast cancer screening and risk. 

BY MAUREEN SALAMON
PUBLISHED SATURDAY, SEPTEMBER 29, 2012
After numerous biopsies on her dense breasts came back benign, Mary Fadie thought she had managed to escape breast cancer. For nearly a decade, she knew from suspicious mammograms and subsequent surgery that she had very dense breasts. But it wasn't until 2008, at age 46, that she discovered a hard, pea-sized lump that ultimately was diagnosed as cancer. The tumor turned out to be one of a malignant constellation in her right breast, joined by a single cancerous lesion in the other.An ultrasound technician with ready access to scans and helpful co-workers, Fadie read conflicting information over the years about how mammographic breast density contributes to breast cancer risk. Her radiologist clarified the matter by insisting that a bilateral mastectomy was the best course after her stage 1 diagnosis because mammograms–which have trouble detecting cancer in dense breasts–might miss any potential recurrences.

“I had so many lumps and bumps, and so many false alarms, that I sort of wrote it off,” says the Colorado woman. “The (density) issue really did seem unknown. Nobody was telling me I was high risk at all.”

Dense breasts contain more fibrous and glandular tissue–which appears white on mammograms, just like cancers–while fatty tissue shows up as gray or black. About 10 percent of women have extremely dense breasts, according to the American College of Radiology, while 10 percent have almost entirely fatty breast tissue and the remaining 80 percent fit into one of two middle categories on a 1 to 4 ratings scale known as BIRADS (Breast Imaging Reporting and Data System).

Women like Fadie with the highest density are 4 to 5 times more likely to develop breast cancer than women at the lowest extreme whose breast tissue is mostly fat, says Carol Lee, MD, a diagnostic radiologist at Memorial Sloan-Kettering Cancer Center in New York City. These women, however, are no more likely to die from the disease than others with breast cancer, according to a 2012 study in the Journal of the National Cancer Institute.

“Fatty tissue isn’t breast cells, although it may be in the breast,” explains Stacey Vitiello, MD, a radiologist specializing in breast imaging and biopsy at Montclair Breast Center in Montclair, NJ. “The more fatty tissue is in the breast, the less real estate there is to develop cancer in. Dense breasts have more ‘active’ breast tissue specific to breasts where cancer forms.”

While the issue has been researched for many years, the gap seems to be narrowing between what doctors and women know about breast density’s link to cancer risk. Thanks to aggressive grass-roots efforts, five states (New York, Connecticut, Texas, Virginia and most recently, California) have passed legislation requiring health care providers to notify women if dense breast tissue is seen on a mammogram, with similar laws pending in Congress and about a dozen other states. An organization known as AreYouDense.org, which offers extensive information about the issue online, has been a huge proponent.

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