Dense Breasts on Mammogram

Dense Breasts?  Isn’t that good?  Doesn’t that make them seem firm and perky?

Dense Breasts on your Mammogram Report?

So, you just got your mammogram report from your doctor and she said, “Your mammogram is normal,” and you breathe a sigh of relief.  Then you are hit with another statement, “But, you have Dense Breasts.”  Wait. What? What does that mean? Am I OK?  What do I do? 

This is a phone call that over 40% of women get from their physicians.  What you need to know is that dense breast tissue is associated with an increased risk of developing breast cancer.  Dense breast tissue can make it difficult to detect breast cancer on mammography.

There are 4 possible tissue categories reported in mammogram reports:

1.     Fatty breasts
2.     Scattered fibroglandular densities
3.     Heterogeneously dense
4.     Extremely dense

If you have a finding of (#3) heterogeneously dense breasts or (#4) extremely dense tissue category your mammogram report will say that you have “Dense Breasts.”

Breasts have gland tissue, fibrous tissue, and fatty tissue.   If you have lots of gland and fibrous tissue, they are considered “dense.” More than 20 states have passed laws that require radiologists to inform women of this finding, have them talk to the physician that ordered the mammogram, and possibly get more imaging.

Mammogram

So, what will your physician do?  He or she will take into account your:

• age,
• family history,
• History of breast biopsies
• When or if you had children
• The consideration that you are at high risk for developing breast cancer

Obviously, the older that you are, the higher your risk of developing breast cancer.  One out of eight women will develop breast cancer in their lifetime.  Unfortunately, it is a common cancer.  If you have a strong family history of breast or ovarian cancer, your risks will be greater.  If you have had one or more breast biopsies, your risk will also increase.  If you have never had children or if you had children late in life, your risk also increases.

This information (and additional information) can be plugged into a computer model to see if you are considered high risk for breast cancer.  There are three common computer models used:

• National Cancer Institue (NCI) Breast Cancer Surveillance Consortium calculator (BCSC)
• NCI Breast Cancer Risk Assessment Tool, Gail Model (BRCAT)
• IBIS Breast Cancer Risk Evaluation Tool (Tyrer-Cuzick model)

If you are considered high-risk, an ultrasound or an MRI may be ordered.  Ultrasound of the breasts helps detect more cancers and is routinely ordered in this instance.  An MRI will detect the greatest number of cancers, but is:

1. very expensive,
2. takes a long time to perform, and
3. is not usually covered by insurance.

    

   

MRI will be covered by most insurance companies if:

• A woman has a genetic mutation for breast cancer 
• A woman has a close relative (mother, father, sister or brother) that has a genetic mutation, or
• A women had radiation of their chests for cancer before they were 30 years old.

Discussion of your risks and options with your healthcare provider is imperative if you have a diagnosis of “dense breasts.”