Dense breast and increased cancer risk

Grammy2be

NCI does not factor in breast density when calculating risk of getting breast cancer. I find that odd as my mammography report says even my moderately dense tissue may increase risk and mammo may miss small areas of concern. Thoughts? I do have a biospy scheduled next week but am wondering if I should be doing more to ensure nothing is overlooked in the future.

muska

I wonder why people are so obsessed with calculating the BC risk. If average in older women is 1 in 8 and suppose average in older women w dense breasts is 1 in 7 and you fall into the latter bucket what does it change in your monitoring/treatment decisions

Grammy2be

I wouldn't say I am obsessed, just looking to be as proactive as possible!

Legomaster225

To me it seems like everyone I talk ito or come across has dense breasts. If there are so of us many that have/had "dense" breasts maybe that is not really so different. All I can say is that imaging, while definitely improving, is not perfect

muska

When it comes to cancer and breast cancer in particular there isn't much one can do to be 'proactive.' We wouldn't have cancer if we could reliably prevent it. One can however, pay more attention to mammo reports, get educated on the lingo and make sure proper follow-up standards are followed if necessary. I think that's all you can do and I also think you should not be doing more than that: worrying about the risks is not going to improve your odds but will definitely make your life less enjoyable.

Shellsatthebeach

Depending on your other risks, I would request for an ultrasound to be done in conjunction with a mammogram since you are 100% correct that tumors can and do sometimes go undetected until the tumor becomes more advanced in nature. Just saying the mammogram didn't do what it was suppose to do is not good enough!

ABeautifulSunset

I would insist on an ultrasound. With dense breasts, three mammograms missed a tumor that was seen in ultrasound, early on and then later, when it eventually grew and became cancer. had I only relied on the mammo, it would have been totally missed. With dense breast, I would insist on an ultrasound, even if you have to pay for it yourselves.

And legomaster, dense breasts IS a real thing. 🙄

Tara17

https://www.ucsf.edu/news/2017/02/405711/dense-bre...

So dense breasts are a risk factor, but the average risk woman , has nothing she can really do about it except making sure to start annual screening at age 40 and asking for an ultrasound

many states in the United States have dense breast legislation regarding reporting on mammograms http://www.nejm.org/doi/full/10.1056/NEJMp1413728#...

So one thing a woman with dense breasts can do is ask for ultrasound screening at the time 0f her annual mammogram

Grammy2be

Thank you everyone! Thanks for the links Tara...

Grammy2be

I have mostly been getting the 6 month follow ups which include a repeat spot check mammo and an ultrasound. Should I skip the repeat mammo to reduce radiation exposure and just ask for ultrasound when I get call backs?

keepthefaith

3D mammos are supposed to be better for imaging dense breast tissue. They are working on developing blood tests for detection. Wouldn't that be great!?

dismay15

3D Mammo found my cancer and ultrasound confirmed it. I had previously relied on standard mammograms and they failed me! They just don't work for women with dense breasts.

Grammy2be

A blood test would be great!

leaf

Mammos, ultrasounds, and MRIs all can detect different things. Both some benign and cancerous lesions can show up on any and all of these imaging techniques.

The 'science' of breast cancer prediction is in its infancy, at least for individuals. In other words, we may know quite accurately how many women IN A POPULATION that may get breast cancer; we just have a really hard time knowing which particular women in that population that will be. In this older study, even when they included breast density and other variables, for individual women, the modified Gail model did 'better than the toss of a coin, but not by much'. Remember, the toss of a coin would mean the prediction model was absolutely worthless. https://academic.oup.com/jnci/article-lookup/doi/1...

In other words, if a model was absolutely worthless, then 50% of the time it would be right, and 50% of the time it would be wrong. In this study of women in Florence, Italy, the modified Gail model, and the 'Italian model' (which included breast density) for individuals was correct about 59% of the time, and wrong 41% of the time. Yes, this is better than 50% of the time wrong, but 'not by much'.

Grammy2be

Thank you Leaf. It seems there is little validity regarding these risk calculators. I have also heard that all these mammograms and ultrasounds may not really be all that useful in the big picture.

Legomaster225

Stefajoy, I was not implying that dense breasts is not a real thing at all. The point I was try to get across was that there are so many of us with dense breasts that it is extremely common. I honestly have not come across anyone that said they do not have dense breasts if the topic comes up. We need to continue to improve our diagnostic tools to detect rumors in dense breasts and to be our own advocate pushing for additional testing if desired. Even with diagnostic mammo, ultrasounds and 2 MRI's one of my cancers was missed. Yes, it was small but if it had remained until next year's mammogram who knows.

I guess I am saying that yes, dense breasts may make it more difficult to diagnose cancers but we are smarter than that and need to continue to push for improved, affordable tools to assist in this effort.

Grammy2be

I have read that there are slightly more women with dense breast tissue than not. I do not know anyone my age that I have dicussed the density issue with. My mom had dense tissue even at 63 yrs old when she was diagnosed. I wish my mom had been more involved in her care after being diagnosed as I feel I could benefit from knowing what her actual type of bc was. She had a stage 3 aggressive cancer is all I really know. She did have chemo and radiation. My younger sisters do not have dense tissue according to their mammo reports.

Could it be that we hear so much about density and the higher risk of breast cancer only because people here are more knowlegeable?

leaf

In this blurb from the American College of Radiology (radiologists would be the people who rate breast density), about 50% of the adult female population have heterogeneously or very dense breasts. https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Breast-Imaging/Breast-Density-bro_ACR_SBI_lores.pdf

MelissaDallas

If you are not very elderly you probably have heterogeneously dense breasts. Most of us do. Only a small percentage of us technically have "extremely dense" breasts, as in more than 75% dense.

Anonymous

I was in the extremely dense category. My gyno NP even exclaimed about it years ago, but never told me what that might mean. I suppose she didn't want to scare me unnecessarily, but I think I would have paid more attention to those 5 clear mammos I got instead of saying "woo-hoo" and not paying much attention to my own regular exams. A random self-check by me probably saved my life--or at least prolonged it a good bit.

Had I known the danger of "extremely dense" breast tissue I would have demanded an U.S. and or even a breast MRI. I might not have been granted the breast MRI, but I would have had more ammunition to protect myself. Oh well, hindsight is always 20/20.

I'm getting an MRI tomorrow as a baseline (so I'm told) to follow any remaining breast tissue from my BMX. As always, I'm apprehensive about what might be in my body threatening my life that I don't know about. Sigh.

Claire in AZ

Whirlaway

I am also in the extreme dense breast category, over 75 %. I just finished treatment and will be followed with MRI this year and next year mammo with ultrasound. The only "good" thing was that I had a very fast growing tumor which popped up over night - my body seems to self screen better than any machine . Pulled my knees up in the morning and left knee hit tumor (which was pretty high up - close to underarm) so if it reoccurs - so hoping it won't!!! - I will know.

PoppyJQ

claireinaz - My doctor hasnt mentioned MRI after BMX for baseline. Is this a pretty standard thing?

Grammy2b - Is your mom still living? Have you tried getting access to your moms medical info? When I went to the genetic counselor she had no problem ordering up my deceased moms file to get her tumor info. I'm sure getting the info depends a lot on the situation, the medical group etc. but thought I'd mention it to you. Best wishes

beach2beach

I was also in the extremely dense category. My sister had/has BC. I had already been getting mammo/sono done. Then it was suggested due to family history that i get MRI at 6mths then 6mths later mammo/sono. Did for about 3 years then ins. said I was not considered high risk anymore. Whatever that means. In the end, mine was caught with a sono. I think you are being proactive. Getting screened regularly. I'd request a sono along with mammo. Is the Mammo a 3d one?

Grammy2be

Thank you poppyJo. My mom is still alive but knows little about her diagnosis and treatment. She leans towards great anxiety so I have not told her about my upcoming biospy, if in the future if I absolutely need more details on her bc type I will see what I can find.

Grammy2be

beach2beach- I am fortunate to have what they call moderately dense breast tissue but the mammo reports always caution me about the possibility of hidden masses. I am 56 and have been getting call backs usually including ultrasound and spot checks as long as I can remember! My latest mammo/US on 8/31 was 3D and was a 6 month follow up to an irregular area and a complex cyst they have been monitoring for a year. Oddly my report says the area they want to biopsy on Sept 18 could not consistently be found on the ultrasound but shows on 3D mammo. They will be doing my biopsy guided by 3D mammo.

VanillaPudding

I also have dense breasts.  In fact, I am considered extremely dense, further categorized as "severe" and noted as having very little adipose tissue.  Even an ultrasound has a hard time seeing through my dense tissue.  I just had an MRI, and it found a Birads 5 mass that was missed on my last 2 Mammo's and Ultrasounds within the last 12 months.  My MRI report notes "marked background glandular enhancement.  So even the MRI is masking any thing going on in my breasts.  I am waiting for my US guided biopsy this coming week, hoping they can at least find the area again.

I have never made it back to 1 year screenings since my baseline at age 40.  I get some type of screening every 6 months  due to follow ups for some type of mass or cyst or fibroadenoma.  In 6 years I have had 10 Mammograms, 11 Ultrasounds, 4 MRI's and this will be biopsy #7, and 4 complex cyst aspirations.  All of these issues are masked by dense breasts.  I wonder what isn't found..........

beach2beach

Grammy, fingers crossed that all is good.

Tara17

vanilla pudding - wish you the best with your biopsy

momallthetime

VanillaPudding if the MRI is the one that was able to get to the glandular stuff, would it not make sense that the biopsy should be done with the MRI and not US (that did not pick it up anyway?) And good luck

VanillaPudding

Momaallthetime,

Yes,  I thought the same thing.  US tech had a very hard time finding the spot, she told me she was unsure and guessed I would be having an MRI guided biopsy.  Radiologist was confident she could identify the correct mass on US.  Who knows, it is all a waiting game for me right now.  So frustrating having these dense breasts.  I am hoping and praying that the Birads 5 mass is only at worst DCIS?  I have been talking with insurance and am researching PBMX right now.  Insurance has preliminary approved the PBMX and reconstruction for now due to surveillance, density and imaging difficulty.  Not a decision I take lightly, but seriously.

momallthetime

I really don't wanna cause you more anxiety, but it does not make sense. Maybe you should ask another Center specialized ONLY in Breasts imaging to opine on the Mamo and MRI you took, or even a Breast surgeon of an opinion, to put yourself through the MAYBE of them finding something on a modality that they KNOW it did not show defies logic. They might want to do this because of Insurance, let them fight with Insurance and prove to them, that it has to be through MRI. Many lesions B9 or even those not b9 only appear on MRI. IF the lesion or questionable thing would not have shown itself on MRI and only on mamo, then MAYBE they'd have an argument that no MRI or US showed it, so they will try US...(because it's cheaper). Just saying....this biopsy via US at this point is ONE RO inkling, NOT based on a/t concrete.