Extremely Dense breasts

are you still alternating with MRIs? What are they saying about those?

Hi,

I had dense breasts. |How can you afford the MRIs or even MRi guided biopsies? I was econ. broke by this. 

Hi Cinvee, I saw that you tried Tamoxifen, and it didn't go well.  Actually, the Tamoxifen and the aromatase inhibitors (for post-menopausal women) are supposed to help reduce breast density.  I also have extremely dense breasts (age 61), and I'm not even getting MRI's as part of my protocol, but I did insist on ultrasounds.  I was told that ultrasounds show solid tumors better and calcifications show up better on mammos. MRI's are notorious for finding all sorts of things that lead to biopsies (most of which are benign).  I imagine that's why I'm not getting regular MRI's, although when originally diagnosed, I was given an MRI, and a nodule was found on the other breast.  The first hospital wanted to biopsy (BIRADS4) and the second said it's probably benign (BIRADS3), so I did end up ultimately with three MRI's but that's the end of it.  And P.S. I am holding off on hormonals, as well.

When I had an ADH/ALH diagnosis 18 years ago, I did nothing special for follow-up other than annual mammos.  You are fortunate to be followed as a high-risk patient.

Hi CinVee, the multiple nodular densities (huge numbers in each breast) seen on the ultrasound, sounds like cysts to me, otherwise they would recommend biopsy.  I'd ask the U of M people about that.  Are your breasts very tender? 

I wish it were easier to for you get though this without the constant fear that the screening will miss something.  I have no answers for that.  I always knew that that was a risk for me; as well, and still is.  Despite very dense breast tissue, my calcs (DCIS) were identified on mammography, and I was told that ultrasound picks up solid tumors.  Since you've got the triple whammy (including MRI's), while your screening isn't perfect, it should be pretty good.  The only thing that all of the screenings are bad at is the very aggressive tumors which show up been screenings.  But there is no way to do anything about that.

I would like to share my story: 

I am 47 years old with "extremely dense" breasts.  I had micro calcifications seen 7 years ago, biopsied and a clip placed to closely watch that area at each mammogram.  I had yearly mammograms (including 4/13) - all fine. Fastforward to Thanksgiving of this year: I felt a lump (same area), was told it was a cyst - but I insisted it be checked out. They sent me in for a 3D mammogram, then did ultrasound where they saw a suspicious area BEHIND the cyst.  Another biopsy: this time they found the cyst contained ADH cells, and the suspicious area was IDC .7cm.  I chose to do BMX 12/3 and before the surgery, I had an MRI with contrast on both sides.  NOTHING MORE WAS FOUND... After BMX, my final path report reported not one tumor of IDC (.7), but three!  All were clustered near first tumor but separate (the others were .8 and .7cm).  They also found .5cm of DCIS in other breast. I am thankful I chose to be aggressive. 

Last week, I was at my local hospital and found a flyer talking about a new law passed in my state (Oregon) effective 1/1/14 -SB420. It states women must be told after a mammogram if they have "extremely dense breast tissue" as these women have DOUBLE the risk of breast cancer (similar to the risk of having a family history (mother, sister or daughter with cancer in one breast, after menopause). Extremely dense tissue is more than 75% dense tissue (not fat). Heterogeneously dense breasts are 51-75% dense tissue and can make it harder to see small tumors which means a "very slight added risk of breast cancer." 

I don't want to scare people, but hopefully this information will help others in the process of making healthcare choices and in discussions with their surgeons etc...

cinvee---when you say "tried tamoxifen--didn't go well", what happened? How long were you on it? (just asking, because the docs will ask you the same questions).  (It very often takes a few to several months for your body to adjust to the tamox. I would suggest evista instead, but you have to be post menopausal.) The fact that the MRI was negative for any findings is very good news. The mammos generally are better at seeing the non-invasive bc's (LCIS and DCIS), while the MRIs are generally better at detecting the invasive bc's. Hoping you have a good experience at your second opinion appt tomorrow.

Anne

I'm in a similar situation.  It seems  like I am less lumpy and hard as I age but I've since learned that density is determined at a cellular level, not by just imaging or clinical exam.  It's entirely possible to have soft feeling breasts and still be judged as extremely dense under the microscope.  

My last excision was 6/13 and the guide wire got stuck.  The surgeon had to take more tissue than planned because the wire was seemingly stuck in a "rock" of tissue.  

Lastly, re: breast density and risk…don't be alarmed by some of the posts.  Just as with nearly everything concerning density and LCIS….there is nothing definitive.  There is supposition that density might pose inherent risk but that has NOT been scientifically proven and most of the scant studies thus far have been retrospective in nature, not clinical.  So, they are digging through past medical files to see if they can determine a link between conditions that could post risk factors and the onset of invasive disease.  At this point, given what they do and do not know, I'd say it's more likely that current diagnostic tests are just not adequate to screen dense tissue with the highest desired confidence level.