Getting Heavy About Dense Breast Tissue

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Nancy always paid attention to her health. She listened to her doctors, ate healthy, nutritious foods and exercised. She performed monthly breast exams on herself; she had yearly mammograms and had no history of breast cancer in her family.

Little did Nancy know that having dense breast tissue was a major factor in possibly developing breast cancer. Three months ago, Nancy was diagnosed with breast cancer and, on the same day, she was informed, for the very first time, that she had dense breast tissue.

Why didn’t the mammogram find the cancer and why was she never told she has dense breast tissue? It was the first time that she was educated about dense breast tissue and its impact on missed, delayed and advanced stage cancer.
What does it mean to have dense breast tissue and how does it affect the women who have it?

Breast tissue is composed of milk glands, milk ducts and supportive tissue, or dense breast tissue, and fatty tissue, or non-dense breast tissue. Women with dense breasts show more dense tissue than fatty tissue when their breast tissue is viewed on a mammogram. Dense breast tissue has less fat and more connective/fibrous and glandular tissue. On a mammogram, dense tissue, although normal, appears white. Cancerous tumors also appear white, making it very difficult to differentiate the tumor. As one doctor points out, “It is like looking for a polar bear in a snowstorm.”

Breasts tend to become more fatty as a woman gets older, but about two-thirds of pre-menopausal and one-fourth of post menopausal women have dense breast tissue. Radiologists have been communicating to doctors for years if a woman has dense breast tissue, but this information is not always conveyed to the patient.

How do you know if you have dense breast tissue?

That’s right; oftentimes we need to take our health into our own hands. A radiologist can see if breast tissue is dense by looking at your mammogram. Make sure to get a copy of your mammography report from your doctor. Confirm that this is the report that is produced by the radiologist and not a form letter. Review the report thoroughly and take notice of the descriptions of your breast tissue. It is a good idea to keep records of your yearly mammograms, so you can view any changes from year to year.

Women may experience more dense breast tissue at certain times in their life. Before or during menstrual periods, breasts may feel swollen and tender and lumps may form because of extra fluid in the breasts. Pregnant or lactating women may also experience more dense breast tissue. Since a woman’s breast makeup can change somewhat during these times, doctors may have a patient return for a follow-up visit after she is finished breastfeeding or at a different time in her menstrual cycle.

I have Dense Breast Tissue. Now What?
If you have dense breasts, making simple lifestyle changes can keep your breast cancer risk as low as possible. Keep a healthy weight and exercise regularly. Eat a healthy diet and get adequate amounts of calcium and vitamin D. Do not smoke or quit smoking and limit alcohol intake.

Talk to your doctor about adding another screening such as an ultrasound, breast MRI or digital imaging in addition to regular mammograms. Some states require insurance companies to provide coverage for a comprehensive ultrasound screening of an entire breast or both breasts if a mammogram shows dense breast tissue based on BI-RADS® or Breast Imaging Reporting and Data System, established by the American College of Radiology.

If you are one of the approximately 40 percent to 50 percent of women aged 40 to 74 in the U.S. who has dense breasts, diligence is important. Being aware and knowledgeable of dense breast tissue is the best defense against breast cancer. By living a healthy lifestyle and taking other necessary steps, you can hold the future of your breast health in your hands. ■

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Understanding Dense Breast Tissue
There are four classes of dense breast tissue based on BI-RADS®.
Mostly fatty: The breasts are made up of mostly fat and contain little fibrous and glandular tissue. This means the mammogram would likely show anything that was abnormal.
Scattered density: The breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue.
Consistent density: The breasts have many areas of fibrous and glandular tissue that are evenly distributed through the breasts. This can make it hard to see small masses in the breast.
Extremely dense: The breasts have a lot of fibrous and glandular tissue. This may make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue.