Read This if You Have Dense Breasts

sumrgolfer

I call myself a radiology nightmare!  Large dense breasts.  I was recently diagnosed with bc in both breasts, DCIS on one side and IDC in the other.  When I first spoke with my surgeon he recommended breast preservation upon which I immediately replied "you're kidding" and then went on to tell him that it was not what I had in mind at all.  He listened to what I had to say and ultimately said it was my decision as to what I wanted to do (why do they all say that?  LOL) but then did make a point of saying "with your dense breasts you never know what will be lurking in there that a mammogram, ultrasound or MRI will not pick up." Something to think about for those of you undecided as to what to do.  The choice for me was pretty cut and dried.  Dense breasts are time bombs waiting to go off.  Just my two cents.

Beesie

texasmom, MRIs are more sensitive.  This means that they "see" abnormalities (i.e. possible cancer) that other screening methods may miss, particularly for women who have dense breasts.  While this might result in more unnecessary biopsies, it also means that more cancers may be caught earlier.

I had a single mastectomy for DCIS/IDC calcifications and because my remaining breast is "extremely" dense, I now get annual MRIs in addition to annual mammograms.  I alternate between mammograms and MRIs on a 6 month schedule.  When I was originally diagnosed, my calcifications did show up on a mammogram, but even more of them showed up on my MRI.  It used to be thought that MRIs weren't good at seeing calcifications but more recent studies have indicated that MRIs are actually better at catching DCIS calcifications.  What was interesting in my case is that when I was diagnosed, I'd also had a biopsy for calcifications that were seen on my mammogram in my other breast.  The biopsy on these was benign and when I had the MRI, they didn't show up at all.  So my cancerous calcifications lit up the MRI, and my non-cancerous calcifications didn't show up at all.  In fact the MRI of the "good" breast came out completely clean, despite having those calcifications and despite having had 4 previous biopsies on that breast.  So personally I like MRIs and feel more comfortable getting them.  Here is some info on MRIs in general and on MRIs & DCIS:

http://www.mayoclinic.com/health/breast-mri/BR00019

http://www.healthcentral.com/breast-cancer/news-40365-66.html

http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_detail_view&confID=47&abstractID=31839

At the risk of upsetting some who have posted here, I want to add a word of caution to this thread.  Having dense breasts is quite common, particularly among younger women.  There are quite a few classifications of denseness, and only the most dense is really a problem for mammograms.  Even then, for some women, mammograms can be effective.  The other thing to keep in mind is that although having dense breasts is a significant risk factor for breast cancer, most women who have dense breasts will never get breast cancer.  Given all that, we need to be careful in suggesting or implying that anyone who has dense breasts should just get it over with and have a bilateral mastectomy.  That's simply not an acceptable option for many women.  And even more importantly, having a bilateral is not necessary for most women, even those who have dense breasts.  In my case, even though I had to have a mastectomy, I opted for a single not a bilateral, despite my extremely dense breasts and despite all my previous biopsies. I'm happy with my decision - it was the right decision for me.  It's been 3 years and I haven't had a single problem since.

I'm not saying that those of you who have dense breasts and who decided to have a bilateral made the wrong decision - not at all.  You made the decision that was right for you.  But we mustn't make women feel guilty for not choosing this option.  We mustn't make women question their decision if they didn't choose this option.  And there's no value in creating fear in anyone who has dense breasts, especially those who don't have breast cancer.

Of course, it's important to build awareness of the risks associated with having dense breasts.  Mammograms and ultrasounds and even MRIs are less effective.  It may be more difficult to detect cancer, particularly at an early stage.  Simply by having dense breasts, your risk to get BC increases.  Knowing that, it's important to be extremely diligent in your screening.  It's advisable to request MRIs.  And if you have additional risk factors (i.e. you've already had BC or you've had numerous biopsies or you have hyperplasia or atypical hyperplasia, etc...), then considering a bilateral is another option.  But please, let's present having a bilateral as an option, not as the only logical decision for anyone who has dense breasts.

rrs

I think MRI, mammography, and ultrasound are all tools that pick up things in different ways.  Somethings show on MRI that don't show on the others and vice versa.  My .9 cm was detected with ultrasound but did not show up on mammography.  Now I do all three.  I've not decided to remove both breasts at this point but have been looking into it. 

kerry_lamb

I have very dense breasts, and consider myself extremely lucky to be alive. In Feb I contracted atypical pneumonia, developed ARDS and spent 6 days intubated in an induced coma. When this happens, our doctors (in Australia) regard ARDS as a screen for something very sinister and start looking hard. I had an old (25 year old scar tissue) breast lump biopsied when I was under. The area was so hard it actually bent the needle! The test came back negative but the surgeon was not satisfied at all. I have biannual mammos, but the last two did not show any change between them. Still, she was unconvinced and did a lumpectomy. Malignant! A round-table conference recommended a mastectomy (no choice, actually) because the panel was unanimous that I could never screen accurately for bc in the future because of the density of my breast tissue. I happily had the mastectomy, axillial resection (to avoid rads now..save them for later if i have to) and have two more cycles of chemo to go. I feel like the luckiest woman alive, especially to have had such an astute and tenacious surgeon...I tried to tell her I was responsible about my tests  and lumps (which I am) but thankfully she just would not let me be! I live to tell about it 

rrs

Wow!!!  What an amazing story.  I'm sorry you had the ARDS but glad they found the cancer.  You have very good doctors! 

rrs

Any thoughts about having breast reduction surgery to help with detection?  I'm very curious about this.

I'm also wondering how many BC patients have dense tissue. 

Thanks to the moderators for putting this topic on a "sticky" note so it will stay at the top of this forum.

MissUniverse

I went in for a mammo after I found a palpable lump under my left arm.  I was told I had breasts so dense "you could hide a mack truck in them".  2 mammo's and an ultrasound only showed 2 suspicious masses.  Then the MRI - they found 2 additional lumps in my left breast and 2 in the right that hadn't showed up previously.  Had core biopsies on all the newly found lumps,  One of the lumps on the left side was definitely cancer, the other was benign.  The 2 on my right side also benign.  Because the newly found lump was in a different quadrant than the initial 2 lumps it was deemed I needed a mastectomy.  I was ok with that, let's get the cancer out of me. While they were in there, they found yet another tumor (2 cm) that didn't even show up on all the other tests.  I won't be having annual mammo's after I get done with chemo (DD A/C & T) but annual MRI's per my onco but have to admit that even doing that, after what I've been through, I'm worried that it may not be enough. My onco is against removing my other breast at this point, but to reduce my risk, I may feel that I want to have it done later.

rrs

Gosh, Laurel!!!  I'm sorry that you've had this experience.  I do wonder why your onco is against removing your other breast?  Did she/he say? 

MissUniverse

He said that he felt that if there were any other masses in the other breast that they would be minimal and would be reduced to nothing with the DD chemo that I am on.  I will undergo another MRI in mid-October when I finish chemo and then we can re-look at things.  It is a hard wait on top of everything else that goes along with having bc.  I believe in him - he is the head of Oncology for the hospital I am getting treated at and the leading breast cancer specialist (32 years experience) in the area I live in.  But I never thought I would look so forward to October.

otter

Oh, darn, this thread is now twice as wide as my computer screen...  (Hint:  I think it has something to do with really long web links.)

otter 

kerry_lamb

Hi rrs.Yes, we have the BEST, well...I have found that out this year  It's just wonderful that our populations are small here and things are accessible as in just 'there'. I am going to have a reduction of the remaining breast next year and a big advantage of that will be easier screening in the future.  ARDS was not pleasant: the priest was called..my family was called..the whole deal. Ironically THAT should have killed me and didn't, so I am laughing in cancer's face. Sure I'm a bit on the shabby side but I still regard myself as a warrior-princess 

Naomi12475

I just wanted to add that having dense breasts DOES NOT ncrease your risk for breast cancer.......it only makes it harder to detect should you develope it!!!

revkat

Naomi, when they first started talking about dense breasts it was assumed that the difficulty was with detection. Now it seems that dense breasts actually DO put you at higher risk for developing cancer, not just for not detecting it. Here's one link http://jnci.oxfordjournals.org/cgi/content/full/92/6/443, but just google dense breast cancer risk. There's lots of discussion why this is relating to different kinds of cells and hormone exposure.

otter

Naomi, revkat is right.  We wish that the only reason dense breast tissue increases the risk of BC is because the tumors can't be seen, so they get dx'd later.  But, they eventually get dx'd.

Unfortunately, there is plenty of evidence now that dense breast tissue is an independent risk factor for BC, separate from its "masking" effects on detection of the tumors.   The news release revkat cited says the risk of BC if we have dense breast tissue is 4 to 6 times higher than if we have fatty breast tissue.  That's pretty much what I've read in medical journals, except I think that degree of risk is usually associated with "very dense" breasts.

In any case, here's an example of the sort of discussion that's going on now among oncos and radiologists, regarding dense breast tissue and BC risk.  This excerpt is from the introduction section of an article published in New England Journal of Medicine in Jan. 2007 (N.F. Boyd, et al.:  Mammographic density and the risk and detection of breast cancer.  NEJM 356:227-236, 2007):

"...In 1976, Wolfe described an association between a qualitative classification of mammographic densities and the risk of breast cancer, and now substantial literature shows that more extensive density is associated with an increased risk of breast cancer.  Women with dense tissue in 75% or more of the breast have a risk of breast cancer four to six times as great as the risk among women with little or no dense tissue.

"Extensive mammographic density may also make breast cancer more difficult to detect by mammography and thus increases the risk of the development of cancer between mammographic screening tests.  Because density influences the detection of cancer, estimates of the risk of breast cancer associated with mammographic density may be distorted....

Whitehead, et al., ... showed that a masking effect of density did exist but that it operated in addition to differences in the risk of breast cancer related to the classification of breast patterns described by Wolfe.  Other studies have reached similar conclusions but have had short periods of follow-up or have not distinguished between breast cancers detected by screening and those detected by methods other than screening.  There are, therefore, few data that allow an examination of the extent to which mammographic density, assessed quantitatively and using modern mammography, influences the risk of breast cancer at screening, between screening examinations, or over time.

"The purpose of this study was to describe the association between mammographic density in the baseline mammogram and the subsequent risk of breast cancer...."

The authors concluded:  "Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests.  A substantial fraction of breast cancers can be attributed to this risk factor."

It still isn't known why dense breasts are more likely to develop malignant tumors.  One popular theory involved the influence of estrogen and other hormones, which tended to increase breast density and increase the risk of BC.  Some recent research papers suggest that the relationship is more complicated than that.  Dense breasts are associated with an increased risk of BC independent of the effect of hormones.

Another unanswered question is whether doing things that decrease our breast density will decrease our risk of developing BC.

otter 

[P.S.:  The reason this text is extending beyond the edge of the screen is because there is a web link in a post farther up this page that is not breaking--it's too long, and it's extending past the normal page width.] 

evieo

Well, ladies and guys, I fit right into this discussion! For TexasMom, let me tell you that no test (mammo, sonno, MRI, nor PET) showed where my Grade 3, Stage 3 cancer was coming from. A PET showed extensive lymph node invasion but they never found the source of this bc. Later I had an MRI that showed a new DCIS cancer that could not have been the cancer that invaded the lymph nodes. I had all chemo before surgery and I too went with a lumpectomy although the onc said "masectomy" and the surgeon said lumpectomy. No bc found in the 9 lymph nodes removed in surgery. All pretty great, huh?

Well, now I have made the decision to have a bilateral mast because of the very thing we re talking about here. I have ALWAYS had dense breast tissue and through out the years I was often called back for a sonno after a mammo. The only reason I insisted something was wrong was because my underarm hurt. I was Stage 3 at dx. I am petrified that I have not done everything I can to survive since I kept the fibrocystic breasts that hid the cancer so well. I expect to have surgery in September sometime.

rrs

Evieo - So you never found the source of the BC???  Good for you for insisting until you got the PET.  I'm confused a little by you post that you had 9 negative nodes - which is great by the way - but your diagnosis line says 3 postive out of 12 nodes...? 

Anyway, thank you for sharing your information.  I'm so interested in your decision to move forward with the surgery.  Was this your decision based on guidance of your physicians or did you just decide yourself? 

Hope you don't mind all my questions but did you have radiation treatment as well? 

rrs

bumping up

Springtime

Always have had dense fiber cyctic breasts. GYN always told me my breasts were hard to examine. Always had clear mamograms, every year. Had a clear screening digital mammogram last year and then this year in May. June had GYN appt, she felt something - but clear mammogram. She's concerned. Diagnostic mammogram, nothing. Ultrasound, nothing. But we all feel this lump, nobody likes it now. Breast Surgeon - Core needle biopsies - IDC. Breast MRI - huge tumor, been there for years, not detectable by mammogram or ultrasound!!!

Very mad!!! Mammograms tell you all is fine, you feel lumps, you think, clear mammogram! IT is like giving us BAD information! I am telling everyone now about Breast MRI.

HOWEVER, HOW GOOD IS BREAST MRI FOR DENSE TISSUE? I have been told that it is very accurate if done on the correct day of your menstrual cycle.

I need to decide uni- or bi-lateral, and I and dh would like to keep healthy breast. I would insist on MRI yearly, but will this be ENOUGH?  Does anybody know the accuracy of Breast MRI for very small tiny changes?

I have seen this and it seems that Breast MRI is a very good test. (See "Breast MRI from the patient perspective by Dr. Coates)

http://www.wakeradiology.com/ForPatients/EducationalResources/tabid/109/Default.aspx

What do you think? 

rrs

I don't know. I worry about the same thing but I think MRI is better than mammography.  There is a new method called gamma camera that is promising.  I'm glad you and your GYN decided to look further. 

Springtime

Gamma Camera, will hae to look into that. Thanks RSS. (Yes breast MRI is better than Mamo, for sure).