For Those with Dense Breast Tissue

I totally agree. I was an A/small B cup. My tumor was 5.5cm before they found it… and that was because I had bloody discharge. I know a MRI would have found it 4 years ago when they thought they saw something, did a US and Mammogram but claimed it was nothing. Yes I had really dense breasts.

This is absolutely true and my story is almost exactly Lee7's.  I went for years for mammograms that never showed my lump.  I had two biopsies, so I absolutely should have had MRIs.  They don't like to give them.  They are expensive, and mammography is the name of the game.  The whole thing feels like a Monopoly game!

Mammography, they do say, can be important to pick up calcifications that could show up even before MRI.  In my case, my lump had nothing at all to do with the microcalcifications in other parts of my breasts.

Regarding chemo and breasts, that is disappointing.  However, the main function of chemo, as I understand, is to get cells that are fatally outside of the general breast region.  Radiation, on the other hand, deals with local.

Hi, Lee--wish I had more info to report on radiation, but I have seen even more information on new technologies and radiation, and they report heart damage as "rare" in the SE category.  I will let you know if I find out anything else from my radiation oncologist, I want to ask him point blank what he can tell me about what they did to my heart (and lungs).  If anything meaningful.

As my radiation assistant said when I asked about radiation causing cancer, "you did a lot more damage to yourself with chemo".  While the guy has the bedside manner of a snake, it's good to think about where we are actually hung up on things, or are really evaluating them from a researched standpoint.

So hard!!!!  I wish you so much luck with your decisions.  It's easy for me to say "do it all", as that's what I did.  But I don't think there are trully right or wrongs here.   The other issue that concerns me, though, in your diagnosis is the fact you had positive nodes.  Just ask a ton of questions.

I was one who did not get mammograms.I found my lump and my journey started.One thing I want you all to be aware of,my first mammogram was of course diagnostic,since I had the lump.The doctor of radiology who read my mammo,never mentioned my dense breasts,nor did he at my follow up the next year.This year I went to a different facility for my mammo and report came back stating that I have very dense breasts and should have MRI in the future.It worries me that other women are most likely not being told they have dense breasts.

Thanks Melissa.  I hope many women read your post and demand a MRI. 

I had dense breasts.  They are both gone now.  I went from a clear mammo in jan 09 to stage IIIC by summer.  Despite a family history of bc and dense breasts, an MRI was never suggested or offered.  I remember having one a few years ago for a back injury and a tiny voice in my head was saying "ask them to scan your breasts".

I disagree with the radiation tech's cavalier remark that "chemo did more harm than radiation".  I think that statement should be mentioned to the radiation oncologist as the tech probably says it to many patients.       He may have meant to allay your anxieties about radiation; but it is a loaded comment in that it raises major concerns about the long-term effects of chemo. 

the tech's job is to deliver the treatment exactly as prescribed. Not to make a judgement on the merits and dangers of different treatments.  

Your concerns about radiation (I forget who posted this story) were legitimate.  Esp if the left breast (above the heart) is being radiated.   With today's specificity of the radiation beam; I made an informed decision to go ahead and do it.  But the tech's response was dismissive. and not accurate.    I went for my radiation treatments every day with a woman who's son was a pulmonary (lung) specialist.    the son was strongly against the mom's decision to undergo radiation b/c he had seen some very rare cases where radiation pierced the lung.     He mentioned the risk/benefit ratio and did not feel the benefit was high enough for the risk.  Of course, that depended on her unique breast cancer situation.      there are other times when the benefit far outweighs the risk    My point being, that your tech was not in a position to make that judgement.

The **trend** is for women to lose breast denseness post-menopausally, or, as they age. This study found that as a group, postmenopausal women had much less breast density than premenopausal women. http://www.ncbi.nlm.nih.gov/pubmed/18385204

I didn't realize this, but lobule atrophy and mammographic breast density apparently are two different things.  I guess sometimes they vary together, and sometimes not.  I don't think they understand the biology.

Lobules tend to atrophy as women age.  This study opines that both breast density and lobular involution (age related lobular atrophy) are *independent* risk factors.  (In other words, high breast density and low lobule atrophy both produced higher breast cancer risk.)  http://www.ncbi.nlm.nih.gov/pubmed/21037116 ,http://www.ncbi.nlm.nih.gov/pubmed/20351335

In this study, " Annual rates of decline were 1.4%" http://www.ncbi.nlm.nih.gov/pubmed/19924817

I know there is at least one poster here who said she is postmenopausal, and she had had very dense breasts all of her life.  They haven't decreased in density.   So you may have a different experience than the mean.

i have one dense breast, and that's where i got cancer. but i had neo-adjuvant chemo (AC+T) and a complete pathological response, so i don't think it is true that chemo doesn't work on dense breasts. At least not in my case...

Doctors need to take dense breast tissue more seriously and do a separate study to determine whether we should have mammograms at all-- each time I have a mammogram, they bring me back for a couple of extras because they are uncertain about something they see -- and then they ask me to come back in 6 months, when, again, I get extra mammograms.  My guess is that we are the group of people where mammograms may cause as many breast cancers as they catch.  Is anyone aware of a controlled scientific study of mammograms specifically with women with dense breasts that demonstrates they do significantly more good than harm?  In any case, I don't want to have another mammogram-- a doctor offered me a sonogram when I asked for an MRI, not sure what to do.

Is anyone aware of a controlled scientific study of mammograms specifically with women with dense breasts that demonstrates they do significantly more good than harm?

Hi Lynnn: I think that your question is very important, but I think it would be very hard to do a direct study.  We can't tell if breast cancer in a patient that has been followed by mammography is from mammography or because of some other cause.   We can only do population studies.  In order to look at the patients with dense breasts, they have to have had a mammogram.  You could take a subset of the women who had never had mammograms and give them one, select out the women with dense breasts, and follow them.  But that's going to take a very long time.    We can only follow models, which are imperfect.  There is no 'safe' dose of radiation (where there is no chance of mutations occuring), but we are all exposed to radiation no matter where we live.  

I have no idea if this study is biased or not, and it does NOT specify anything about breast density,  but it claims:

Two-view digital mammography and screen-film mammography involve average mean glandular radiation doses of 3.7 and 4.7 mGy, respectively. According to BEIR VII data, these studies are associated, respectively, with LARs <lifetime attributable risk> of fatal breast cancer of 1.3 and 1.7 cases per 100,000 women aged 40 years at exposure and less than one case per one million women aged 80 years at exposure. Annual screening digital or screen-film mammography performed in women aged 40-80 years is associated with an LAR of fatal breast cancer of 20-25 cases in 100,000. http://www.ncbi.nlm.nih.gov/pubmed/20736332

For a cohort of 100 000 women each receiving a dose of 3.7 mGy to both breasts and who were screened annually from age 40 to 55 years and biennially thereafter to age 74 years, it is predicted that there will be 86 cancers induced and 11 deaths due to radiation-induced breast cancer. Conclusion: For the mammographic screening regimens considered that begin at age 40 years, this risk is small compared with the expected mortality reduction achievable through screening. The risk of radiation-induced breast cancer should not be a deterrent from mammographic screening of women over the age of 40 years.http://www.ncbi.nlm.nih.gov/pubmed/21081671

I am completely new to this whole process.  I am 38 years old and am now on day 14 days post bilateral mastectomy.  Both BRCA1 & 2 familial history, mother just recently diagnosed Stage 1 and I had dense breasts...for the last 2 and 1/2 years I have run the gauntlet with biopsies, lumpectomies , doctors, mammograms, ultrasounds, needles and a whole lot of attitude (by radiologists and non listening docs).  I am waiting for for first fill of the tissue expanders and I don't know what questions to ask, where to ask, and how to begin.  I feel that I shouldn't be overwhelmed...but I am.  I was told by mother in laws friend; to come here for questions and help....My Aunt is in Stage IV and I am worried about her...and she worries about me; I am struggling with all the unknowns.  Sorry to ramble, and thanks.  

leaf; thanks for the in-depth answers you give. I appreciate the time you put into your posts. I haven't caught up on reading all the data was I have flagged the citations.

I write separate posts b/c I hate when I lose one and there is no back-up copy. Maybe someone can help me with that.

As for u/s with mammo, the u/s is only as good as the person who is doing the scan.  I always went to a radiologist in Manhattan.    

Neither of my two, 2.5 cm lumps could be found on a mammogram (my first at age 37). An ultrasound found them, and a MRI found other areas in the one breast. The other was clean as a whistle. So after my left mastectomy, I asked myself how and why would I ever trust just a mammo again? No one else brought this up, mind you.

I have to wrestle with my drs each year--seems like even they have a short memory on my particular case--but so far have always managed to get an MRI. My insurance makes me get a mammo first, so I do that but then insist on the MRI. I had to fight for insurance to pay it the first time, but I had the dr send them my original mammo that showed nothing and then the ultrasound and MRI that followed on top of it, and they paid. I'm thinking/guessing/hoping having it approved that once is acting like a precedent--they've automatically paid every year since.

I don't think many dr's actually tell patients if they have dense breasts, and I don't think it appears in such plain language on most mammo reports. I've learned that "areas of fibroglandular tissue" or something like that means dense breasts. I've taken tamoxifen for 3.5 years, but I'm still dense.

Yeah, we need new breast screening methods that work for dense breasts, and we need to make them available to all women starting much earlier than age 40. Until then, MRIs should be offered routinely to younger women.

I asked the radiologist when I had my last biopsy how dense my breasts are.  He said, 'Dense, but not extremely dense.'   Hopefully, if you're able to personally speak to the radiologist after a routine mammo, they would be willing to tell you.  Here's a website that has pictures of breast density, and claims patients can estimate for  themselves (but I wouldn't want to do so.) http://www.halls.md/breast/density.htm

I don't advise using  his breast risk calculator  though- it hasn't been compared to populations, and is not peer reviewed.  I got a breast cancer risk some 3 times higher than my other sources.