Breast Density

withlove

Can someone possibly explain a reason why my breast density changed from one mammogram to another?

 My mammogram 6 months ago indicated I didn't have dense breasts, the most recent indicated hetergenously dense breasts!!! I wish I had looked over it to ask the Onc on time at my appt last week.

Now I'm debating if I should demand ultrasounds + mammograms because of the finding-- no one from my medical team has ever mentioned this to me!

Anyone who has this breast density thing down, care to enlighten me... 

peggy_j

Yes, it's a tricky issue.  Keep in mind that it's not an all-or-nothing thing but a matter of degree. This page has examples:

http://u-systems.com/women/know-your-breast-density-classification

FWIW, my breasts are now considered 50% dense and my insurance won't authorize a B-MRI as a screening test.  My MO claims that mammograms can be effective with that amount of density (vs. tissue that is more dense). But I'm still fighting to get the B-MRI.

It's possible that your breast tissue hasn't actually become more dense but that the language to describe it may have changed.  There was a controversy in California that many women didn't realize they had dense breast tissue, so perhaps the doctors or standards have changed and they are being more clear in their language. Who knows? (this is speculation on my part).

Prior to demanding any more tests, I'd probably ask to have someone review your two most recent mammograms with you to discuss your specific case (vs. my random ramblings . This year I had my first post-BC mammogram and asked to meet with the diagnosing radiologist to review it. He put the two up side-by-side and discussed what he saw. Not sure how common this is. If I was still concerned, I wouldn't ask for another mammogram--more radiation--but perhaps an ultrasound. (though my sense is that an US may be more helpful when they are looking for something specific)  FWIW, my experience is that my MO has some knowledge of mammograms but isn't the expert (the way the diagnosing radiologist or surgeon might be, since they look at 'em every day)

Beesie

Heterogeneously dense is the 3rd category of denseness:

Mammographic breast composition is described as follows:
1. the breast is almost entirely fat (<25% glandular)
2. scattered fibroglandular densities (25-50%)
3. heterogeneously dense breast tissue (51-75%)
4. extremely dense (> 75% glandular) 

Source:  http://www.radiologyassistant.nl/en/4349108442109

Categories 1 and 2 are not considered to be a problem.  The biggest concern is with Category 4, "Extremely dense" breast tissue (which is how my radiologist describes mine, lucky me!).  Category 3 is of some concern but it may depend on where you fall in the range.  These ratings are somewhat subjective, and in the middle range, two radiologists could look at the same films and rate them differently.  So if you are at the bottom end of the "heterogeneously dense" scale, it's very possible that 6 months ago the radiologist made the judgement that your breasts were about 45% dense and didn't warrant a mention, whereas this time the radiologist made the judgement that your breasts are just over 50% dense and therefore included the notation about your breasts being heterogeneously dense.  

I'd recommend that you talk to your doctor - or better yet, the radiologist, if you can speak to him or her - about it before you get too concerned.