Dense breasts and lumps

Be sure to have an MRI.  Ultrasounds and mammograms don't work with dense breast tissue. 

Fibrocystic breasts are not the same as dense breasts.  

Approximately 60% of women have fibrocystic breasts.  Fibrocystic breasts are a hormonal condition that is most severe when women are young and usually eases at menopause.  Although fibrocystic breasts often feel thick & lumpy and can appear dense on a mammogram, having fibrocystic breasts does not means that you have the type of density that increases your risk of getting breast cancer.  The type of density that is a real concern with regard to breast cancer risk only affects about 10% - 20% of women.  Women who have truly "dense" breasts tend to have more density than most when they are young and continue to have dense breasts after menopause.   You need the radiologist who performs your mammograms, or your doctor who reviews the mammo report, to tell you if you have these "extremely dense" breasts that put you at risk. You cannot tell if you have dense breasts just by how your breasts feel.

I thought that it was important to clarify this because we don't want the 60% of pre-menopausal women out there with fibrocystic breasts to all think that they are at high risk to get breast cancer. They are not. 

Sheena, in your case, since the radiologist told you that you have "very very dense breasts for a 21 year old", unfortunately that does suggest that you may be in the high density group, which would increase your breast cancer risk.  In general mammograms are not recommended for younger women because their natural breast density makes it difficult to read the mammogram; in your case, this problem would be even greater.  So I would agree that getting an MRI is a good idea.  And I would agree that going forward you should be very diligent in your screening, with annual ultrasounds and, if possible, annual MRIs.

As for your current lump, the fact is that approx. 95% of lumps are benign.  Of those that can't be clearly identified on a mammo, ultrasound or MRI film and that therefore require a biopsy, 80% turn out to be benign.  Those percentages are for all women of all ages and all risk levels.  For someone as young as you, the odds would be even more greatly in your favor.  In younger women, the most common lump is a fibroadenoma.  I had one when I was 16 and another at 20.  They are harmless.  And they are driven by hormones. Since you mention that you have 3 kids, if you've recently been pregnant, that could easily explain the development of a fibroadenoma.  The next most common type of lump in someone your age is a cyst.  I've had more cysts than I can remember.  They are almost always harmless too. 

So try to take a deep breath and relax.  The odds are extremely highly in your favor that this lump will turn out to be nothing serious.  As for being high risk, if in fact you are, the good news is that you've learned this at such a young age, which allows you to start screening now.  Although I admit that sometimes it was a pain in the butt to always have to go for my screening tests and I would get frustrated that I'd so often have call-backs and biopsies, I decided to view it as a positive thing.  The way I looked at it, if I was to get breast cancer, at least the odds were really good that it would be caught early.  As it turns out, I did get BC (33 years after my first lump) and it was caught early.  So the way I see it, it's a whole lot worse to be high risk and not know, or even just to be average risk but never go for your screenings.

Good luck with your appointment with the surgeon.  Please let us know how it goes.