HCA Midwest Health - March 19, 2021

Breast density – it’s one of the breast cancer risk factors that you normally don’t hear much about. But a woman with dense breast tissue has a similar risk to someone with a family history of breast cancer. So it is just as important to know your breast density as it is to know your family history. Being aware of your breast density – and knowing the steps you can take to assist in catching cancer early – can help provide some peace of mind and improve outcomes.

We spoke with Stephanie Graff, MD, and Dr. Nisreen Haideri, MD, of Sarah Cannon Cancer Institute at HCA Midwest Health to find out what you need to know about breast density and cancer risk.

Who has dense breasts?

Dense breast tissue is normal. About 50 percent of women age 40-74 have dense breasts. It is most common in women under 50 years old who have not yet gone through menopause.

Can dense breasts become less dense?

The density of the breasts can change over time. Studies show that the greatest decline in breast density occurs when a woman is going through menopause. However, many older women still have dense breasts (up to 44 percent in their 60s and 36 percent in their 70s).

Density and your risk

Having dense breasts can affect your risk of breast cancer in two ways:

  1. Women with dense breast tissue have a higher risk of developing breast cancer.
  2. Having dense breasts can make breast cancer harder to detect on mammogram images.

Do I have dense breasts?

The only way to know your breast density is to have a mammogram.

“Firm breasts do not equal dense breasts. Breast density is determined by how a mammogram image looks, not breast size or texture,” describes Dr. Graff.

Dense breasts are breasts that have more fibrous tissue (connective tissue) and glandular tissue (the tissue that produces milk), as opposed to fatty tissue. On a mammogram, fatty tissue will appear darker or black. Dense tissue will appear lighter or white.

Breast cancer screening – one size does not fit all

Like any cancer, early detection is key. According to the American Cancer Society, when breast cancer is caught at an early stage, the five-year survival rate is over 90 percent. Mammograms are the only screening test for breast cancer that has been shown to decrease the risk of death.

“The concern with dense breast tissue appearing white on a mammogram is that some cancers and pre-cancers also appear white,” states Dr. Haideri. “This creates a masking effect and can make any changes or cancer difficult to detect, which decreases the effectiveness of your mammogram.”

Standard 2D mammograms produce a limited number of flat images from the top and side angles. 3D mammograms (digital breast tomosynthesis) produce hundreds of images in layers. This increased visualization can make it easier to distinguish cancer from overlapping tissue.

Studies suggest that 3D mammography has greater sensitivity allowing for better cancer detection in women with dense breasts and can reduce the need for additional screening tests.

“Talk with your women’s imaging team about your breast density and your best approach to screening,” says Dr. Haideri. “You can decide between a 2D and 3D mammogram at any time before the screening begins.”

3D mammography is covered by most major health insurance plans. Your women’s imaging team can also answer questions about potential costs.

For women at higher risk, there are additional screening options, including breast MRI and a whole breast ultrasound, which may be recommended and can increase the rate of cancer detection. Talk with your doctor about your options.

Mammograms and the COVID-19 vaccine

As the COVID vaccine becomes more readily available and is extended to younger, healthier people, one thing to consider is the timing between your mammogram and vaccination.

“It is recommended to get your mammogram before vaccination starts or wait four to six weeks after the second dose,” explains Dr. Haideri.

Swelling and pain in the armpit have been reported in 11 percent of people who received their first dose of the COVID vaccine and 16 percent after the second dose. This can happen about two to four days after the shot is received and can last one to two days.

Advanced mammography in Kansas City

Talk with your doctor about your breast cancer risk, when you should begin screening and your mammography options. Screening is recommended annually beginning at age 40 for women of average risk.

At Sarah Cannon Cancer Institute at HCA Midwest Health, we make getting your mammogram as comfortable and convenient as possible, with amenities like patient-friendly compression paddles, soft screening pads and 3D mammography at eight locations in the KC area.

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