Is there a Rating system for density?

Well here's a site that describes different mammographic densities. http://www.halls.md/breast/density.htm    I asked my radiologist when I had a biopsy.  He said I had 'dense, but not very dense' breasts, which I guess corresponds to the next-to-highest density.

I do not recommend using Dr. Hall's breast cancer risk calculator though, at least if you have an unusual condition such as LCIS (like I do).  He states his breast cancer risk calculator has NOT been peer reviewed or compared to appropriate populations.  I don't want anyone to have a heart attack.

You're welcome, of course!  He must have upgraded his website in 2008, because before that he didn't explain you are looking at the % of (?pure) white stuff on the mammos.  He only said you aren't looking at the brightness or darkness of the mammos.  It makes more sense to me now. 

I don't know if breast density shows up in ultrasounds.  At my first ultrasound biopsy attempt (unsuccessful - they couldn't find the lesion) - the radiologist said in passing 'that's a ___ lobule' or something.  Maybe he said degenerated or something, I don't remember.

There's a thread about MRI and breast density somewhere recently.

mawhinney, there are several ways to rate the density of breast tissue. Here are some examples.

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This is a fairly old article, but it provides an overview of the most common rating systems. The link is from Medscape, so you might need to register to access the whole article.:

“Imaging the Dense Breast” by Marla R. Hersh, MD
Applied Radiology. 2004;33(1)    http://www.medscape.com/viewarticle/468145

"Dense breast tissue has been defined in at least three different ways:
--Four progressively more dense patterns, first defined by John Wolfe, MD, and now referred to as Wolfe patterns (N1, P1, P2, DY).
--Four progressively more dense patterns defined by the American College of Radiology (ACR) Breast Imaging Reporting and Data system (BIRADS; ACR, Reston, VA): 1) almost entirely fat; 2) scattered fibroglandular densities that "could obscure a lesion"; 3) heterogeneously dense that "may lower the sensitivity of mammography"; 4) extremely dense that "lowers the sensitivity of mammography."
--Percentage of parenchymal tissue density (compared with fat density) on the craniocaudal mammogram, as measured manually by planimetry, or by computer software programs.

"For clinical purposes, most descriptions of breast density today use the BIRADS terminology.

"Kolb et al has further clarified the BIRADS definitions based on the amount of fat "interspersed within the area of the densest fibroglandular tissue" and the size of the area encompassed by the tissue. His classifications are:
--Grade 1: Having no areas of tissue that could obscure cancer.
--Grade 2: Having at least one area of tissue that could obscure cancer.
--Grade 3: Having tissue that can obscure cancer in 50% to 75% of the breast.
--Grade 4: Having tissue that can obscure cancer in >75% of the breast.

"In general, dense breasts are considered BIRADS categories 3 and 4. … "

[I found a link to the original article in Applied Radiology; looks like it's open access:  http://www.appliedradiology.com/Issues/2004/01/Articles/Imaging-the-dense-breast.aspx]

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This 2nd article explains the Wolfe and BIRADS density rating systems in more detail:

“Mammographic Density: Use in Risk Assessment and as a Biomarker in Prevention Trials” by Carol J. Fabian, and Bruce F. Kimler
J. Nutr. 2006;136(10): 2705S-2708S  http://jn.nutrition.org/content/136/10/2705S.full

"Multiple methods have been developed to assess mammographic density, with reasonable correlation between techniques. Wolfe was among the first to identify certain patterns of density on mammography films that were likely to be associated with increased risk. He described a pattern of N1 as composed almost entirely of fat with little to no radiologic density; P1 as scattered density occupying <25% of the breast; P2 as heterogeneous density occupying >25% of the breast with ductal prominence; and DY as homogeneous sheetlike density in >25% of the breast area with no ductal prominence. The greatest relative risk was associated with the DY pattern.

"The BIRADS system developed by the American College of Radiology is similar to the Wolfe categories and describes breasts as 1) almost entirely fatty; 2) scattered fibronodular tissue; 3) heterogeneously dense; and 4) extremely dense. The proportion of women having BIRADS category 3 and 4 dramatically decreases with age. Eighty percent of 40- to 49-y-olds, 54% of 50- to 59-y-olds, and 43% of 60- to 69-y-olds have category 3 or 4 density. However, only 20% of 40- to 49-y-olds, 5% of 50- to 59-y-olds, and 2% of 60- to 69-y-olds have extremely dense category 4 breasts."

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Finally, here's a long article that discusses a few of the rating systems and also talks about different methods of measuring breast density:

“Mammographic density. Measurement of mammographic density” by Martin J Yaffe
Breast Cancer Research 2008;10:209
http://breast-cancer-research.com/content/10/3/209

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When I had my mammogram 2 months ago, the radiologist said (yet again) that the tissue in my remaining breast was "dense".  "How dense?", I asked, mentioning that I'd heard there were ratings scales -- like BIRADS -- for mammographic density.  The radiologist acknowledged that some centers used the BIRADS density scale; but mine doesn't.  My center uses a 3-step scale:  the least-dense tissue is described as "primarily fatty tissue," and the most-dense tissue is described as "primarily glandular (dense) tissue."  Mine falls in that highest category. 

otter

[Edited to add quotation marks, clarifying what I've quoted from the articles.]

Interesting!

Listen to gin2ca, ladies....I had mammos every year - digital, diagnositic mammos - by the time I found my tumor (noticed the skin dimpling) it was stage II with lymph node involvement. 

PLease, if you have dense breasts, demand at least an ultrasound with your mammos (even if you have to pay for it). 

Radiologist says I am grade 3 density. 

leaf,

I laughed at your comment on the Hall model. The first doctor I met with did a risk analysis using three models. The risk ran from 3%-80%, which I think might have been the Hall model. She said the same thing as you. Don't have a heart attack. She noted that she wasn't going to even talk about it except that she felt that I had done my homework based on what I was asking her, and said she appreciated my organization. I had prepared a list of questions (2 pages) separated by topic (surgical, oncology and general). I also faxed them to her office (doing the same thing with each doctor) the day before so she might have a chance to look at them and have some answers prepared to make the meeting more efficient. Worked very well.