Dense Breast Tissue

I didn't read this whole article, but it does look like hormone levels affect breast density, with less estrogen equating  to less dense breasts.

http://www.dslrf.org/breastcancer/content.asp?L2=1&L3=4&SID=130&CID=1159&PID=4&CATID=0

Here's one part:

It is interesting to note that some women who start on hormone therapy to treat menopausal symptoms find that their mammograms become denser. We also know that women who start taking tamoxifen (an estrogen blocker) to prevent or treat breast cancer will show a decrease in density. Furthermore, these changes in density have been found to happen within weeks. Combining these observations with the findings of this current study on breast density might suggest that women whose mammograms become denser because of hormone therapy should consider stopping their use of this menopausal treatment. At the very least, it is worth studying.] 

I'm still premenopausal and have very dense breasts too.  In Nov 2005 I had my first mammogram because I was 40, and was told everything was fine, no abmormalities.  Only 10 months later, in Sept 2006, I was laying in bed when I noticed a lump the size of an almond in my breast that eventually turned out to be malignant.  It was just by chance that I felt it.  The tumor turned out to be 2.5 cm, and my surgeon said it was actually there for about the past 8 years or so, it just wasn't big enough to be seen or felt until I noticed it.  However I doubt it took 10 months for a 1" tumor to suddenly appear and it wasn't that aggressive.

For most women, the density of their breasts does tend to reduce as they move into menopause but that's not always the case - my breasts are still "extremely dense" (according to the radiologist) and I'm a few years into menopause.

rrs, my BC was found in the form of calcifications.  They were seen on my mammogram but then when I had an MRI, a greater area of concern showed up.  It turned out that the entire area that was seen on the MRI was DCIS.  So my mammogram showed some of my BC, but not all of it.  I also had an ultrasound but calcifications tend not to show up on ultrasounds (for anyone, not just women with dense breasts) so my ultrasound didn't show anything.  I will add that over the years I have had various problems - fibroadenomas, cysts, fatty deposits, benign calcifications, cancerous calcifications - and between mammograms and ultrasounds, all the problems were caught.  I suspect that because I have very dense breast tissue, it probably was harder to diagnose the benign conditions just from the films, so I may have ended up having more biopsies than necessary.  To me, that's a small price to pay for peace of mind.  As much as I hated being sent for a biopsy, I always felt comfortable that at least I was being well checked out. 

To your comment and question "I've read on this website that people have MRIs, mammos, U/S and physical exams - tumors are found or not found by various means - it is all over the board.  What makes some show up where others don't???"  This probably isn't the answer you are looking for, but what you described is normal.  It's to be expected.   I think because mammograms tend to be the focus of breast cancer screening programs, many women believe that mammograms will show everything, but the fact is that they don't.  While mammograms are usually used as the first screening tool, it's known that mammograms sometimes miss things and don't always show things clearly. No expert will ever say that mammograms are perfect and will catch everything.  Cysts are much more clearly identified on ultrasounds than on mammograms.  Same thing with fibroadenomas.  Ultrasounds, on the other hand, don't usually show calcifications. Mammograms are much better at this.  And recent studies have shown that MRIs are even better at showing high grade cancerous calcifications.  Each of these technologies (mammogram, ultrasound, MRI) uses a totally different method to "see" inside the breast.  Each method is better at detecting some things than other things.  So depending on what the problem is, and where it's located in the breast, it might be detected by a mammogram, it might be detected by an ultrasound or it might be detected by an MRI.  Maybe all 3 will show it, maybe only 2, maybe only 1.  The important point is that as long as the problem shows up on something, it means that the screening worked.  I get concerned when I see posts from women who are so worried because their mammogram didn't show anything, even though their ultrasound or MRI did.  That's just not so unusual.  It's just the way the screening process technology works. 

For women who have dense breasts, this problem certainly may be compounded, since the mammogram image may more difficult to interpret for women who have dense breasts. But usually ultrasounds and MRIs are effective.  So there is no reason women need to be overly concerned just because they have dense breasts.  Aware that they have an higher BC risk, yes. Extra diligent with BSEs, yes. Aware that mammograms might be less effective, yes.  Insist on ultrasounds and possibly MRIs, yes.   Extra screening may be necessary, but for most women with dense breasts, that should compensate for the lack of clarity from mammograms.

Now, it is true that some women have lumps that don't show up on any screening tool.  That is certainly a problem, but that's not the case for most of us.  Why it happens in these cases, I don't know.  What to do about it is up to the individual and her doctor.  Certainly a bilateral might be appropriate, particularly if a BC diagnosis was made with no screening tools showing any abnormalities.  But not everyone in that position wants to have a bilateral, so risk assessment needs to be done and other things can be considered, such as Tamoxifen or AIs. 

The important thing to realize is that for most of us, screening has proven to be effective.  Maybe not a mammogram, but there are other screening tools that can be used on women whose breasts don't show up well on mammograms.  For most of us, having dense breasts doesn't mean that screening won't work. 

rrs, I can certainly understand why you are considering bilaterals.  My only concern is when a bilateral is presented as the only reasonable option for anyone who has dense breasts, which is a bit of the tone that comes across in the other thread.  It's one option - and for many women, it's the right option - but it's not the only option and I wouldn't want anyone reading these threads to be frightened into thinking that it is. As you say, it is a very personal issue.  And a very difficult decision. 

I'm curious, other than cysts, have you had any other problems or false alarms since your diagnosis?  I'm sure that part of the reason that I'm more comfortable with my dense breast (I have had a single mastectomy) is because since my diagnosis 3 years ago, I haven't had any problems.  This is the longest I've gone in at least 20 years without a call-back or biopsy or cyst or something.  So even though my breast tissue is still very dense, it seems to have calmed down. I've also had so many false alarms over the years that I feel pretty sure that if anything is in there, it will be found.  My BC was found early.  And I'm comfortable with my screening -  I can't tell you how happy I was when the radiologist suggested that I go for annual MRIs in addition to mammograms.   So for me, that works.

My wife has dense breasts both because of size and young age.  Our doctor told us that breasts become less dense with age.  My mother in law supposedly had large dense breasts as well.

I think my mother in law having a double mastectomy 20 years ago prepared my wife for the inevitable which has now occurred.  We've been told numerous times how lucky we are that my wife's OB/GYN found the  <2cm IDC in her DD breasts.  Radiologists and other technicians doing biopsy have all had a hard time finding it.  While my wife was told that the lumpectomy was an option, the opportunity to choose for a double mastectomy was a no-brainer for her.  She does not want to have to trust that her physician will have to get lucky again to fin it in her other breast.

I must say this was my wife's decision and she has been told she was one of the most prepared patients having emotionally gone through it 20 years ago with her mother and then 4 years ago with my own mother.  In fact my wife is having the same surgeon as my mother.  It just made my wife all that more comfortable with the decision she felt she was going to have to make some day.

Erik

http://route53.wordpress.com/