Breast density

I believe it is quite common for young women to have dense breasts. At 51 my dr said I had the breasts of a teenager ( and that was not a compliment)! I don't know if it affects your risk, but it definitely affects the quality of screening. I asked my genetic doc about screening for my daughter and since she is at least third generation at-risk he suggested she have MRI's.

Love that site www.areyoudense.org/



Please be aware that having dense breast is indeed a high risk in itself!



Find out what your breast density is, ask for your report from the radiologist center you had your films done and hopefully that included a ultrasound because mammo's alone miss many malignancies in women with dense breast.

alrz1980, as others have mentioned, at 33 years old, it's quite normal to have very dense breasts.  The following study showed that 30% of women under the age of 40 had Class 4 Extremely Dense breasts, and another 51% had Class 3 Heterogeneously Dense breasts.  Even your sister, at age 50, does not have unusually dense breasts.  This same study showed that 49% of women aged 50 - 59 had Class 3 Heterogeneously Dense breasts (as your sister does) while another 9% of the women in that age group had Class 4 Extremely Dense breasts.  

The Relationship of Mammographic Density and Age: Implications for Breast Cancer Screening

It is true that having very dense breasts does increase breast cancer risk, but the "4 times the risk" or "6 times the risk" numbers that we often see can be misinterpreted.  Here's what we know.  We know that the average breast cancer rate across all women in North America is 12.4%, i.e. 1 in every 8 women will develop breast cancer at some point over their lifetime. This 12.4% average breast cancer rate includes all women, with all types of risk factors and all types of breast density. What we also know is that as the above study shows, across all women of all ages, approx. 55% have either very dense breast or extremely dense breasts.  So consider that the 12.4% average breast cancer rate for all women already includes these 55% of women who have high breast density.  Another way to put that is to say that the 12.4% rate is already factored up to account for the the fact that 55% of women have dense breasts.  Of course the 12.4% is an average; those who are lower risk (including those with low breast density) will have a lower risk and those who are higher risk (including those with high breast density) will have a higher risk.  But in the end, it all adds up to 12.4%.

When we see comments that having dense breasts increases breast cancer risk by "4 fold" or "6 fold", it is often assumed that this means 4 times or 6 times the 12.4% average risk level, i.e. risk levels in the range of 50% - 70%.  But that's not true at all.  These "4 fold" and "6 fold" increases compare the breast cancer rates for post-menopausal women who have the lowest breast density - class 1 (approx. 10% - 12% of all post-menopausal women) to other post-menopausal women who have the highest breast density - class 4 (approx. 5% - 6% of post-menopausal women).  The following study found that for post-menopausal women aged 50+ who did not take HRT, the ~40 year breast cancer risk (from age 50 into one's 80s) was 6.9% for those with Class 1 density and 17.7% for those with Class 4 density.  So it's clear that those with extremely dense breasts (a small minority of post-menopausal women) are at significantly higher risk, but the risk level may not be nearly as high as many believe.

Breast Cancer Risk by Breast Density, Menopause, and Postmenopausal Hormone Therapy Use

For those who are pre-menopausal, the risk levels are even lower.  Having extremely high breast density does increase your risk, but this increase is against a very low risk level.  Overall women in their 30s face only a 0.44 breast cancer risk (spread over the 10 years of one's 30s). That's the average risk.  Even if your risk is triple the average (I just pulled that out of the air), it's still only 1.3%, spread over 10 years (or 0.13% per year).  Breast Cancer Risk in American Women

What's most important for those with dense breasts is ensuring that they are adequately screened.  Often that means having an ultrasound in addition to a mammogram, or sometimes, having an MRI.

Hope that helps and it's just confusing!

maiyen, as a general rule, MRIs would not be recommended for someone who is 38 and has heterogeneously dense breasts. 57% of women in your age group have heterogeneously dense breasts (in other words, your breast density is normal for your age), and MRIs are notorious for discovering things that turn out to be nothing serious.  That leads to lots of unnecessary biopsies, and biopsies themselves can lead to scar tissue and more problems (including the need for more biopsies) down the road.  At your age, the recommendation is usually an ultrasound, not an MRI.

Normally when MRIs are suggested for women with dense breasts, they are talking mostly about post-menopausal women who have extremely dense breasts.  Or they are talking about situations with younger women where there is an area of concern that needs to be checked out further.  And that seems to be your situation.  You've had a biopsy and you continued to be monitored for two masses in your breast.  Having a baseline MRI might be a good idea, as a check to hopefully find that nothing suspicious is going on.  But on-going.... personally I think that once you get the 'all clear' and are no longer on follow-up, there should be no need for MRIs.  Not at your young age and with heterogeneously (vs. extremely) dense breasts. Ultrasounds, I think, would be a better option.

I think the Are You Dense website is great in raising awareness but I also think it's raises too much fear because it is so general in the information that's provided. The concern that a woman should have - and the breast cancer risk that she faces - if she has heterogeneously dense breast tissue in her 30s or 40s is completely different than if she has extremely dense breast tissue in her 60s.  Yet this is never explained on the website (at least not that I can find). What the website needs is less anecdotal information about women with dense breasts who were diagnosed with breast cancer and fewer general statements about breast density and risk levels, and more information about what normal breast density levels are by age.  The site should also better explain breast cancer risk levels by age for each level of breast density.  "4 times the risk" sounds scary but if the base level of risk for someone in her 30s is only 0.02% per year, increasing to 0.08% per year at "4 times the risk" isn't nearly as scary. And they should explain better what screening is advisable by age and level of breast density.  It is very important that every woman know her breast density and the site does a great job in educating women about the importance of knowing their density.  But I've seen too many women come to this site scared to death thinking that they are doomed to get breast cancer (and sometimes even thinking that they should have prophylactic mastectomies) because they've been told they have "dense breasts".  Yet most of the time it turns out that these women have completely normal levels of density for their age, and often their breasts are not even all that dense.  Better education and information about breast density is needed.

Also, i want to make the point the breast density rating is of course a subjective rating. 

re my own personal experience:  My breast density was rated "3" hetergenous yet, an abnormal mass measuring well over 2 cm. was found by MRI.  It was invisible, literally, on the mammogram. Post surgery a smaller part of this measured as invasive cancer.

So, hetergenous I have learned is considered "dense". Dense means that mammograms aren't good enough.  If you are at least a "3" you need something more in addition to mammgram, at least an ultrasound.

jessica, I agree that maiyen should be getting the MRI.  But lots of people read these posts and I wouldn't want everyone in their 30s (or even 40s) with heteorgeneously dense breasts to think that they need to have an MRI.  An ultrasound is usually the preferred option.  And yes, I agree completely that with level 3 density, at whatever age, an ultrasound should done.

Beesie, good, we are in agreement. I know, I overreact totally based on my own personal experience. Many of us do!!! My bmx was an 'overreaction'. I told my surgeon very rationally I knew I was 'overreacting" to the diagnosis but that it was very thought through, on my part, and a decision which (albeit extreme) was right for me.  (I also had ADH, so always was going to be someone who would need 2x a year imaging at least-mammo plus u.s. or mri- and knew I didn't want to deal with it and the ongoing anxiety, time, expense, around it at this point in my life - clearly not a decision as easily/quickly made had I been younger than 47, etc.).

Beesie, you are right that the whole dense issue is pretty confusing and can be somewhat misleading. When I first started having breast issues, I wanted to try and educate myself on everything that I could and came across areyoudense and other various websites about density and many times I saw the connection between dense breasts and MRIs, but there was nothing about age being a factor, how dense breasts in younger women would not be considered unusual, etc. I have been having annual mammos with US every 6 months, but this last visit showed growth via mammo and virtually no growth via US. My BS said that US is typically more accurate when it comes to measuring, but I don't think she liked the fact that there was a decent amount of discrepancy between the two. And she had brought up the high risk, and with everything else...I think she decided that MRI would be best.

When my BS first recommended an MRI, I expressed concern that insurance would not cover it and she explained that because of my dense breasts and high risk factors...it probably would (and should). And then when I contacted my insurance and learned what their specific guidelines are in order for MRI breast screenings to be covered, it all made sense. But in all honesty, if I didn't have my own personal experience with insurance and my BS...I would have probably assumed that I should get an MRI just because I have dense breasts.

Jessica749, as far as why I am monitoring the lumps rather than removal...that is actually kind of under debate right now. The facility that I go to right now has explained to me that their surgeons are very conservative and unless there is definite cancer, they will not remove lumps and I'd have to seek an outside surgeon for that. I'm being monitored because my large lump is about 5 cm and they don't feel comfortable letting me go on the basis that the core biopsy had a benign finding and such little tissue was tested vs the majority of the mass which was not. I've heard from others to leave it in, take it out, get a second opinion...it is driving me nuts. And I really don't want to pay for an MRI only to have turn around and get an excisional biopsy because someone decides that it needs to be removed.

Beesie, I agree. In my instance, because I did have ILC, which grows differently than IDC and doesn't often appear as a mass (hence, my five clear mammos that didn't show my 2 c. involvement) I chose to remove my breasts. I'm happy with my reconstructed ones, even if they are more cosmetic than anything. But I didn't have my surgery till more than a year after lumpectomy, chemo and rads finished, giving me ample opp to talk to everyone on my med team, including a radiologist, who told me that for dense breasts and ILC (if you don't want to go prophylactic BMX) MRI IS THE GOLD STANDARD.

I had to insist on the second mri; the radiology office "allowed" it because I had a mammo in August '12 and it had been less than a year.  Both showed no hyperplasia because it was indeed ILC once again.

I thought: do I want to go through mammos and radiation from that every year, and fight to have MRIs, or do I want to be done with a lot of the worry and the mistrust that I experience because mammos didn't work for me?  For me the choice was simple.

But a knee-jerk removal just because you "might" get BC later in life isn't something I would ever advise. Inform, inform, inform yourselves, ladies; if it isn't an emergency (you have a confirmation of BC) don't panic.  We are our own best health advocates. No one else cares more about our health than we do, and everyone's situation is a bit different because we are all unique individuals with different lifestyles, personalities, worries and health issues.

Good luck to all who face this difficult decision. I appreciate the discussion here about this serious issue.

Claire

Bump.

Has anyone had a 3d mammogram? Wondering if this is better than an MRI. As I was getting my mammo last year, the tech mentioned that she thought I should have a 3d mammo the next time I came in because my breasts were dense. This was before I was diagnosed. My surgeon has scheduled my next mammo for Feb 2014 and this has been a good reminder to see if I can get scheduled for the 3d mammo.

Here is some interesting reading about breast density and the new California law http://pinklotusbreastcenter.com/breast-cancer-101/2013/05/the-california-breast-density-law/

Also there is a good map of states that are working on/have passed bills at areyoudense.org

I personally contacted someone in my state legislature today about formulating a similar bill. I was always informed I had dense breasts but did not know the degree of density.