Are Dense Breasts High Risk?

Tamodeez

I have a small amount of density in one breast. Does that make me high risk? I'm confused with everything I read. Some say yes, some say no. Do they mean very dense breasts? I've also read that my density should go away after menopause? Has anyone ever had some dense tissue in their breast that went away?

bisous3

My breast tissue changed so significantly in one year, going from dense to fatty, that I had a big scare with my yearly mammogram. The island of dense tissue that was left looked so much more more pronounced from the year before that they wanted me to go for a biopsy based on what they saw in the mammogram. Thank goodness my friends husband is a radiologist who specializes in breast MRI.....I had one of those instead and the results were totally normal. They were just watching normal breast changes, but I am glad they were being vigilant with me.

Anonymous

from what I've read, dense breasts are not indicative of high risk in and of themselves. It's the fact that they are so much harder to image by mammogram that causes the higher risk. Hence the need for MRIs which are better for women with dense breasts.

Beesie

My understanding is the same as what awb said. Dense breasts do not increase your risk of getting breast cancer. But dense breasts do make it more difficult to read a mammogram or ultrasound, so the concern is that something significant could be missed because it's thought to be just dense breast tissue. So extra diligence is required in reading the films, and many of us with dense breasts get frequent call-backs for diagnostic mammograms, not because there's a problem, but just to get a closer & better view of the breast tissue to be sure that nothing's going on.

Anonymous

I just read an article a few days ago about this. It suggested that everyone find out their 'density score that is based upon the ratio of fatty to non-fatty tissue in the breast and did indicate that women diagnosed with bc seem to have the highest density scores. Apparently, these scores appear on all detailed mammogram reports (I believe it said they read as percentages, the highest percentage grouping being the most dense), but are rarely passed along to the patient. I can't find the article I was reading, but our site here at bc.org has this to say about density and risk for bc:

http://www.breastcancer.org/research_genetics_091902.html

Marin

leaf

Thanks for the link, Fitchick!

Here's some information about how breast density is estimated from a radiologist from Alberta, Canada, at a major teaching hospital there. http://www.halls.md/breast/density.htm

I have heard comments that for women with dense breasts,
a) not only is it harder to read their mammos because its like looking for a
snowman in a snowstorm - its hard to tell the normal tissue from the abnormal tissue.

b) *if i remember correctly*, I thought someone opined that an increased breast density meant there are probably more lobules/ducts in the breast tissue. A lower breast density meant there is more fat, which normally surrounds the lobules/ducts. So more dense breasts may have more sites at which breast cancer might start. This would assume that breast cancer normally starts in the lobules and/or ducts, which may or may not be known.

http://www.ncbi.nlm.nih.gov/sites/entrez...Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/sites/entrez...Pubmed_RVDocSum

It sounds like in many populations of women without breast cancer, that dense breasts increases risk. We may need more information about quantifying how to measure breast density, whether risk factors in a particular case are additive, etc.

To get my breast density, I simply asked my radiologist, and he said my breasts are dense, but not very dense.

cp418

Lea - My understanding of risk was the same as you described. I had a benign fibroadenoma age 19 removed and then age 49 diagnosed with bc in the same breast. This breast shows denser and more lumps than the other on mammogram. I also had 5mm DCIS inside my 1.8cm IDC and am convinced it was missed on previous mammogram. It was a more aggressive DCIS and then turned IDC. I thnk the Bi-RADS score is related to the breast density evaluatin as I was unable so far information of a separate rating for breast density (unless radiologist just state mild, mod, severe). Joann

zoey1

I wonder if any of you have gotten HMO coverage for your MRI based on having dense breasts. I was diagnosed last year and had a lumpectemy and radiation. My tumor was all the way out near my armpit and the mammogram technician said last week it is very, very hard to get a picture of it. In addition, I have very dense breasts which is why my primary feels I need yearly MRIs. Nevertheless, my stinkin HMO denied coverage.

With warm regards,
K.

cp418

K - FIGHT THEM!! Talk to your doctor and get him/her or who ever to send a letter why it is necessary for you to have them done. I am in a similar situation and we have to be heard. There are numerous articles out ow supporting breast MRI for high risk woemn and we fall in that category now. Make lots of noise aboout and don't let them get away with it. The way insurance companies get away with rejections is because not many people are willing to fight them. Joann

zoey1

I definitely plan to fight them. They have been horrible through this whole process; they denied amost every claim which meant I had to write countless letters while receiving treatment, surgery etc...I truly hate this system!

lilahope777

I too have extremely dense breasts and my original 2.3 cm lump did not show on the mammogram despite being right below the nipple. Now I'm post-chemo, rads, and on Tamoxifen. My HMO SPECIFICALLY excludes Breast MRI's for "screening" due to breast density, even if you've had bc. I'd like to challenge/appeal this but am unsure of how to go about it. Is it possible to appeal when it is already in black-and-white that it's excluded? Would love to hear any words of advice . . .

Janet

zoey1

Well, I am going to make an appointment with my primary and ask her to compose a letter which cites the American Cancer Society's recommendation of MRIs for high risk women as well as explain the reasons a mammogram is inadequate for bc patients with dense breasts. My company has an insurance broker who I will ask to advocate for me as well. I'll let you all know how this goes.

Warm regards,
Karen

Made

In order to appeal - I would get a letter from my physician, include ACS documentation and a note explaining why Breast MRI to you and then send the letter not only to the HMO, but your State Department of Insurance, your State Representative and Senator, if you can get the information - all the representatives and senators on that are on the Insurance Committee for your state. There's a great story on voicesofmammosite.com from a woman that changed the options of radiation treatment for her whole state. Good Luck!!

cp418

Maybe this site might help.

http://www.house.gov/house/MemStateSearch.shtml

We have to start some where on the state level and be heard.

floridian

Regarding insurance - I have successfully won appeals on other issues so they can be fought successfully. I wonder if they could put the MRI as diagnostic? I just had my second one today and the order says "diagnostic bilateral breast MRI". I have had two biopsies but they were OK - fibroadenomas. I do have very dense breasts and the radiologist said that they could not see the lump they took out on the mammo. He suggested the MRI. Does dense mean the same as lack of fat? I am very thin and have dense breasts. I would have to guess that since breasts are made up of milk ducts and fat, that lack of fat would leave the ducts which would be dense. They have always told me that mammos are almost useless for me. Anecdotally, everyone I know that has had breast cancer has been thin - has anyone else noticed this? Maybe I just happen to know more thin people.

floridian

I found the information that was referred to here regarding density scores on mammos. Does anyone know if this is the same as assessment category? Mine said Assessment category L-2Benign, R2- Benign but as I mentioned before they said they couldn't see a thing on my mammo - 2 does not seem high if the scale is 1 to 4.

http://jnci.oxfordjournals.org/cgi/content/abstract/99/5/386

http://www.cancer.gov/ncicancerbulletin/NCI_Cancer_Bulletin_032007/allpages

Quote:
By linking BCSC records to cancer registry data, a capability built into BCSC data collection methods, the investigators identified 2,639 incidences of breast cancer in the group. Women diagnosed with breast cancer were more likely to have received a breast density score of 3 or 4 on their first and last mammogram than women without cancer. Overall, a high breast density score assigned on the first or last mammogram was associated with an increased likelihood of breast cancer.

Importantly, the rate of breast cancer diagnosis increased for women whose breast density score increased from first to last mammogram, and conversely decreased for most women whose breast density score decreased from first to last mammogram, with the exception that risk remained high for women with a breast density score of 4 on their first mammogram.

Indigoblue

My ignorance regarding the danger and risk in regards to Dense Breast Tissue is why I found a lump, stellate, 1.7 x 2.5 in length, IDC, Triple Negative Hormone Receptor, Stage Ib, after experiencing pain and numerous mammograms for 7, 8 years; discovering the lump 3 months after an ultrasound and 2nd mammograms of the left breast; told it was b-9, and treated somewhat like a hypochondriac. There was pain, and for years, the radiologist and OBGYN and family physician told me I had dense breasts.

The prevailing attitude was that healthy breasts are dense, and it was impressive as to how healthy my breast were; and even tho I had continuous pain, the density as a possible misread dx was never mentioned. Family history, aunt, mother and grandmother, all should have raised the red flag. MRI should have been immediately done; but I was told to come back the following year for the yearly mammo.

Why a Scintomammogram, MRI, or even Ultra sensitive Ultrasound not administered? Noone mentioned seeking a breast cancer specialist. I didn't know there were specialists who could help to diagnose the pain; dense breast render mammomgrams useless. If the pain and other myalgia been found while in-situ, perhaps the invasive bundle of cancer cell with vascular invasion could have been halted. Genetic intervention was never mentioned either. I knew it was likely hereditary, which is why I was pretty certain something sinister was going on in the left breast. , perhaps the last year and a half would have been one without pain, anxiety, fear, and ongoing side effects from surgery, chemo and rads. Dense breasts...lumpectomy,
really a partial mastectomy, cut nerves, have somehow removed my former life from it's place in time, as I have finished treatment find myself waiting for recurrance.

I do not believe there is a cure; nodes, calcifications, cysts, and breast pain continue to appear. I ask for the flipping MRI and treated as tho I've had the sniffles;

Personally, mammograms in dense breast tissue are almost worthless; in fact, I suspect the radiation exposure may even excite the cancer cells enough to entice a wake up for these cells to attack otherwise healthy breast cells and tissue.

Thanks for all your info. It backs up some of my theories regarding breast cancers, DNA, dense breast hidden dangers, and the remarkable complicated cell, hormone, enzyme, and proteins which are like a precious fragile clock, a system unknown, with untold medical mysteries and unfounded barbaric treatments which are costly and profitable for the entire medical, insurance and law community...

Dense breasts? I feel like a chump.

The medical bills are incredible, and I have the best insureance one could aquire. The prescriptions, medical research, the entire biz...sometimes I feel like a pawn in the medical chessboard.

Feeling particularly annoyed by this entire experience;
and wondering why so many of us are treated like insignificant creatures being led to the slaughter.

Quality of life?
'
My life ended the day I found the lump.

And it continues to fall apart.

Dense breasts? Dense mind, emotion, spirit and life.

I feel dense; head to toe.
The ignorance and self denial continue to torture me.
I knew better, but chose to ignore something my subconcious knew was there.

If you have dehse breast tissue, get the best possible medical professional care. It's treatable if caught early.

Indi

Peaches70

You are so right. I felt really stupid last year when I found out 1) microcalcifications ARE something to be concerned about and 2) dense breasts are nothing to be proud of. For years I've had "twinges" but never thought anything about them. After all, I'm a coffee drinker. If nothing else, my experience over the last year and a half has taught me to trust myself, stand up for myself, and take care of myself. I will no longer stand for being not being taken seriously. I will not take it for granted that all doctors have my best interests at heart.
I wish I could keep myself from obsessing every time I find out I have to have a biopsy. Is that typical? I am trying to stay busy with everything else in my life, but that appointment keeps popping up in my thoughts.

leaf

Quote:

---

I wish I could keep myself from obsessing every time I find out I have to have a biopsy. Is that typical? I am trying to stay busy with everything else in my life, but that appointment keeps popping up in my thoughts.

---

I don't know if you are typical, but you are definitely not alone. I obsess whether I'm having screening or not. If I'm having a biopsy, of course I'm even more anxious. If the 'area of concern' was due to a potential error on their part for not catching it earlier, I'm livid.

LCIS + ALH

Peaches70

One more article that says definitively YES, dense breasts are high risk.
http://www.medicalnewstoday.com/articles/80168.php

Indigoblue

Hi all,

Yesterday I had the first "bilateral mammo" and "bilateral ultrasound" follow-up (had a digital). I've had so much under, inside, outside, axillary and breast pain, the Radiologist (new, fresh, brilliant), discussed the preliminary results in an effort to calm my fears.

I asked her about "dense breast tissue", and expressed my concern as so often cancers are missed. She explained that "dense" does not mean high, low, big, small, perky, muscular, or anything (darn, I used to think it meant I'd never have droopy breasts, duh).

Breast which are "dense" generally means you are at high risk for developing cancer somewhere, and if you do, it will likely be missed by a standard mammogram. That's why Digitals are better, more accurate; and why MRI's are recommended for use in conjunction with the Digital Mammogram; if caught early, chances of recuurance and overall survival are improved.

The Radiologist said she loves to see "fatty" breast tissue; which always surprises the patients; but the mammograms are far more accurate, and fattier breasts seem to be less likely to develop many types of breast cancer.

She did not see any areas of concern on my digital mammo or ultra, but I still want an MRI. Why won't they let me have an MRI? I suspect (in my opinion), insurance and hospitals don't/won't pay because of the high risk already confirmed in the original surgery. MRI's are pricey (almost the same a the price of a new car!).

Besides, as a Triple Negative, Grade 3, Fam His High Risk, it's likely predictable I'll have a recurrance, even tho I am given smiley faces and led to believe I am "cured". They tell me to stay away from research and to live my life; even tho my hands, body, brain, and former self are now a heap of mush, zapped elctrodes, and goo; an MRI would likely be a waste of money and time.

I truly don't understand; saw my wonderful chemoboy and he also denied my request for an MRI. At least he loves to talk the talk about molecular science, physics, cell activating receptors, and incredible research surfacing after years of studies and clinical trials. Such a cool oncoman!

Indi

Marie_S_

Quote:

---

...The Radiologist said she loves to see "fatty" breast tissue; which always surprises the patients; but the mammograms are far more accurate, and fattier breasts seem to be less likely to develop many types of breast cancer...

---

I've got those "fatty" breasts radiologists love to see. I think they've always been that way even when I was very young...never any lumps, bumps and always a bit on the mushy side. I still got breast cancer anyway (although it was low grade). I never used to like my breasts and always wished they were the firmer, better shaped kind. But now I'm grateful for those two "fatties" for being the way they are since they allow me to have a reasonable degree of confidence that any mammograms done on me won't miss anything hidden behind dense breast tissue.

leaf

You may find this website helpful to learn more about/figure your breast density. So I could be much more objective, at my last biopsy, I asked the rad. Once you're high risk, I've normally gotten a short oral eval at the end of my mammo/us.

http://www.halls.md/breast/density.htm

P.S. You may **not** like Dr. Hall's breast risk calculator (his model gave me the highest risk of any estimate I have had), but he is a head radiologist at the Univ. Alberta, a major teaching hospital, so should know something about breast density. Regarding his breast cancer calculator: He specifically states esp for the questions on the lower half of the website: his calculator has **not** been peer reviewed or compared to the risk populations. It does have journal references though.

LittleG

I use to think "dense breasts" was sort of a compliment. It meant they were "perky" right? Well, they were/are. But I was also dx with ILC a little over a year and half ago. I have since had another bx in my "good" boob that is so far OK. So..dense...yes, get it checked!! And the insurance, keep harrasing them!! I just came back from a committee meeting with Komen about this exact subject!! It's a huge problem. Insurance companies should not be dictating our wellness!!! Fight back!

g

ravdeb

http://www.sciencedaily.com/releases/2007/08/070820104420.htm

I just read this and thought this would be of interest...

Beesie

Interesting!  That's for posting.

One comment in this article really struck me: "Recent research has suggested that having dense breast tissue may be partially an inherited genetic trait."  

As we know, currently it's believed that only about 10%-15% of breast cancer is inherited.  Yet there are so many of us out there who've tested negative for the BRCA genetic mutation and yet come from families with a history of breast cancer (or related cancers).  I've always believed that in addition to inherited genetic mutations such as BRCA, there likely are other factors that can be inherited that may increase our risk of breast cancer.  This is exactly the sort of thing that I wondered about.  If you look at a list of risk factors for breast cancer, estrogen level is a key factor, as are things like "age at first period", "age at menopause".  These are all factors that are in part hereditary, yet those of us whose BCs may be caused by these factors aren't considered to have hereditary breast cancer.    Our knowledge about what causes breast cancer is getting better, but we still have a long way to go!

cmharris59

Just thought I would add my 2 cents... I, too, have very dense breasts and for years was told I had nothing to worry about with regards to breast cancer. I found the lump in my left breast during self exam; nothing found on tests. I have had several mammograms, and even MRIs to chest due to severe asthma over past several years. I was shocked! I was low risk for breast cancer?!?! Now my life has ended.

I have gone thru chemo to shrink the tumor. Tumor responded well but microcalcifications in breast continue to increase. Mastectomy scheduled for Friday. More chemo and rads to follow before recon can be done. And don't even get me started on recon. From what I have seen most of what is considered acceptable is horrific.

I thought I was an intelligent and well read woman.  I supported bc research and the acs.  I thought a lot of progress had been made.  I cannot believe that we are still using the same drugs that they used 30 yrs ago and women are losing their breasts even when they do catch the cancer early - I am stage 2, or worse yet even before cancer is detected (prophylactic).

Personally IMHO, I find it reprehensible that the medical community considers progress when all they have seemingly done is stop prescribing HRT which causes bc and prescribing prophylactic mastectomies to lower the numbers of bc cases.

I wish e1 would write their congressmen state and federal and copy John Edwards as well, citing their experiences with the medical community and the insurance cmpanies.  I think all of our elected officials should be required to stop at the bc web sites and read every post from women going thru this horrible ordeal 

Peaches70

This article was alarming to me, a post-menopausal woman with extremely dense breasts. It makes it sound like there is NO chance for me NOT to get cancer. I knew I was high risk, but...

Anne

Hindsfeet

I completed menopause almost five years ago. I am now 63 and had my first mammogram in about 10 years in November. The technician kept saying your breast are so dense that they are hard to read. She said it was like looking through a wall in stead of a window. At that time I took it as a compliment to have perky breast that hadn't aged. After going back into the waiting room I was asked to come back into the room for more pictures. The next week I was called back for a echo pictures, and a biopsy.

I've read you can have dense breast through your sixties. More and more older women have denser breast. Especially women who live in cities....(stress?)

Why? ...late menopause? Estrogen in our food? Stress? Fat's?

the technician said at the biopsy denser breast are higher risk for b.c. I think mostly because the lobes and ducts are still enlarged.

I am also est and pro + .

VBG

I know that dense breast tissue puts you at a 5 fold greater risk of getting bc.  My initial bc was only visible on ultra sound and was found "by accident" when they called me back to relook at my cysts.  I asked for and got an MRI prior to surgery, I wanted to be sure there were not other masses that were just not visible.  Lumpectomy stage 1, grade 1 ICS/ILC 1.5mm est/pro+.  Did follow up radiation and tamoxifen.  Dec '07 asked for and got a breast MRI due to my "high risk", mammos and ultrasounds were clear.  MRI showed a 6mm mass that turned out to be an off shoot of the orginal cancer ( they failed to mention this in the original MRI, they thought the spot was benign) and a 2mm new mass.  ILC can be very difficult to see on mammo!  Now preparing for bilateral mastectomy and reconstruction (nipple sparing surgery).  Since tamoxifen does not work for me am now looking at IAs and the possibility of ovaries being removed since I am premenopausal. 

Fight hard for MRIs, expert radiologists in the field believe this should be the standard of care for younger women and definitely for women with dense tissue.  Be sure to ask for digital mammos it does make a difference.

I wish someone has explained the risks for women with dense tissue , calcifications, type of cancer....I would have made different choices!

leaf

Unfortunately, the ACS guidelines specify that there is insufficient evidence to recommend for or against MRIs for *screening* for women with dense breasts. A major institution told me I had too much scar tissue, and no screening MRIs. (I have LCIS, ALH, and dense, but not very dense breasts.) Believe me, I'd at least like a baseline. I can't even get the major institution to send the report to my onc!!



Insufficient Evidence to Recommend for or Against MRI Screening

Lifetime risk 15–20%, as defined by BRCAPRO or other models that are largely dependent on family history

Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)

Atypical ductal hyperplasia (ADH)

Heterogeneously or extremely dense breast on mammography

Women with a personal history of breast cancer, including ductal carcinoma in situ (DCIS)



Recommend Against MRI Screening (Based on Expert Consensus Opinion)

Women at less than 15% lifetime risk



http://caonline.amcancersoc.org/cgi/content/full/57/2/75