Dense Breasts? Now What?

Congratulations! You finally did it.  You have conquered your fear of  the awkward and slightly uncomfortable task of having your mammogram.  All is well and you leave the office with a sigh of relief and a pat on the back.   The next day you receive a letter in the mail which reads…

“Your mammogram indicates that you may have dense breast tissue.”

Your head starts spinning, you can’t breathe and you don’t even see the following words…

“Dense breast tissue is relatively common and is found
in more than forty percent (40%) of women.”

This week alone I have received calls from two panicked young women that received such a notice in the mail.  They were scared and confused.  “What does it mean that I have dense breast tissue?” “Is that what you had?” “I don’t understand.  It says my mammogram was ‘normal'”  “Do I need to have an ultrasound?”

Why Did I Receive This Notice?

In our state, as well as 9 other states, a new law requires mammography providers to notify women if they have dense breasts.   The law states the following wording must accompany such notification: 

“Your mammogram indicates that you may have dense breast tissue. Dense breast tissue is relatively common and is found in more than forty percent (40%) of women. The presence of dense tissue may make it more difficult to detect abnormalities in the breast and may be associated with an increased risk of breast cancer. We are providing this information to raise awareness of this important factor and to encourage you to talk with your physician about this and other breast cancer risk factors. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”

What Is Dense Breast Tissue?

Now that you know why you have received the notice, you may be wondering “what is dense breast tissue?”.   The American Cancer Society states:

“Breasts are made up of a mixture of lobules, ducts, and fatty and fibrous connective tissue. Lobules produce milk, and ducts are the tiny tubes that carry milk from the lobules to the nipple. The breast lobules are sometimes called glandular tissue because they produce milk. The fibrous connective tissue and the fatty tissue give breasts their size and shape and hold the glandular tissue in place.

Your breasts are considered dense if you have a lot of fibrous or glandular tissue but not much fatty tissue. Some women have more dense breast tissue than others for reasons we do not clearly understand. For most women, breast density decreases with age. But in some women, there is little change. Breast density is very common in many women, and it is not abnormal.” 

What Does Dense Breast Tissue Look Like?

This is a picture from American Cancer Society which shows the difference between fatty tissue and dense breast tissue.  When a radiologist looks at your mammogram he can rate the density on a scale from 1-4

photo-1

Why Is It Important To Know If I Have Dense Breast Tissue?

As you can see from the picture above, the more dense your breast the ‘whiter’ the tissue shows on the image.  When a tumor is present it will also appear as either white spots or a white mass (if larger). Having a denser breast tissue can make it harder for a doctor to find tumors in the breast. Yet, most breast cancers can still be seen on mammograms. Also, having dense breast tissue may increase your risk of developing breast cancer.  Currently, no one is certain why dense tissue increases a woman’s risk of cancer.

Do I Need Any Other Tests?

Although tumors can be harder to see in dense breasts, radiologists are  knowledgable and skilled to read mammograms with dense tissue and cancers can be detected. You should talk to your doctor about the level of density in your tissue, risk factors and family history.  They may wish to do an ultrasound or MRI.  Although these tests can detect tumors not found on mammograms, they can also show findings that are not cancer.  When this happens, it can result in unnecessary biopsies and other tests. The best advice is to always, always, always consult your doctor.  He or she can help develop a health care plan that is specific for your needs.

Now What?

Knowledge is power.  When you know more about your body and risk factors you and your doctor are able to monitor, screen and discuss appropriate options for health care specific to you. Knowing you have dense breast tissue brings awareness to your self-exams.  Now you know why you may feel “lumpy and bumpy” but if you feel a new lump/bump  or anything unusual or changes in your breast, call your doctor or breast nurse without delay.

Contact Your Doctor

As always, if you have any questions or concerns about your health please contact your doctor or breast nurse.  Don’t be afraid or embarrassed.  I promise they have heard every symptom, story and concern imaginable…no matter how gross or embarrassing it may seem.

Links: American Cancer Society: Breast Density and Your Mammogram
BreastCancer.org: Having Dense Breasts
North Carolina Passes Breast Density Law
General Assembly of North Carolina, Session 2013, House Bill 467

One comment

  1. Maura says:

    I am just finishing up treatment for Invasive Ductal Carcinoma. I found a lump, then had a mammogram and ultrasound, which the Dr told me was just a cyst, (WRONG!) come back next year for your yearly mammogram. I found it very interesting, after getting all my records to bring somewhere for a second opinion, that the reports the Dr gets after mammograms are very different from the forms we patients get. I get a little form with a checklist-1 ( )Return as recommended by physician for routine mammography, 2 ( )Your comparison mammogram has been read. I am recommending that you return in one year for your next mammogram, 3 ( )At the time of your exam you had a specific concern. The mammogram ultrasound is negative. Please follow up with your physician 4 ( ) You should continue with follow up as we have discussed

    The reports that my Docs (primary phy and gyn) are much more specific, regarding dense tissue, saying it lowers the sensitivity of mammography in the early detection of breast malignancy.
    I really would like to of known that I had dense tissue that made reading a mammogram a guessing game! Instead I got “a letter, in layman’s terms explaining the findings and recommendations of this study has either been sent or given to the patient”

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