Gentle Reminder for Those with Dense Breast Tissue

I just want to add that MRI did not detect my 4 mm tumor which was found after the surgery. I have heard that putting iodine on the breast reverses the breast from dense to normal. Has anyone done this and got results? Is there anything else to help with density of the breast?

I had at the higher end of heterogeneously dense side (almost 75%, but not enough to be pushed into being extremely dense). A good number of pre-menopausal women have breasts of at least 50% density. Density just mean you have at least 50% glandular/connective tissue, and less than 50% fatty tissue. Density in most women reduces after menopause, though a few women continue to have high density. Other things that can reduce density is Tamoxifen as it interferes with the estrogen uptake by estrogen receptors in breast tissue.

Density itself is not a huge "risk factor" in itself and studies that show it were, as I recall, on post-menopausal women with extreme density. It is a small base multiplier, but they do not know if it is due to the imagine issue, or because density can be a better environment for cancer growth. The issue with density is more to do with mammography.  Which is also the only way you can determine if there is density. Glandular and connective tissue shows white on mammograms. So do lesions/cancer. Mammography therefore can have a higher false negative rate than it would in fattier breasts. Ultrasound and MRI are better imaging in that case as a further imaging. Some jurisdictions have density laws that require women to be informed if they have density, and be referred for ultrasounds, others don't. If you are somewhere that does not, asks the radiologist ahead of time that you want that information, and ask your doctor, it you do have density, to follow up with ultrasound. Some higher risk women qualify for MRIs but they are not standard of care due to expense and high false positive rates.

Very interesting study Bounce. I had not read that. Thanks for the link.

Many primary physicians are not necessarily aware of the density issue and screening. It is not often their area of expertise and so they might not think anything of it when they see a report saying a patient has dense breasts.The research and issues around density are still a rather "new" area.

You bring up a good point though, Hopeful, about the letters patients receive may not be the same as the reports between the radiologist and the referring physician. I have always asked for the full reports, either from the imaging facility itself or from my physician once he received it, so I could see for myself if there were any areas they mentioned that were not reported to me, etc. Every patient has a right to have copies of their own medical files, and asking for copies of your key records is a good practice to get into.

I don't think dense breasts make mammograms useless as my cancer was detected by mammogram.  However, I do think they give a somewhat false sense of security.  It's possible that a mammogram will fail to detect some cancers in those with dense breasts.  Therefore, those who are notifed they have dense breasts should discuss with their doctor the use of ultrasound/MRI in addition to mammogram, particularly those at higher risk.  

Hi,

I was diagnosed with invasive ductal carcinoma on 8/8/14.  I have always been very good about having my mammograms, doing the self exams and even took Tamoxifen for 5 years as a preventive measure due to my family history of breast cancer.  I have been told since starting having mammograms that I had very dense breast tissue.  A few months ago, I kept noticing that my right breast would ache...it wasn't terrible and it wasn't all the time but it felt different.  I went to my gyn, who I've known for years, and he didn't think there was anything to worry about but due to my history, he ordered a diagnostic mammo & us.  The mammo showed no changed from previous one done 10 months earlier.  The us showed 2 areas that the radiologist wasn't sure what it was so he recommended a us guided needle biopsy.  I went to a breast surgeon who sent my mammo & us downstairs to their breast imaging radiology for a second reading.  The radiologist, who was the director of the breast imaging, called me the next day & told me she agreed that there was no change in the mammo but that there were 2 masses, one that she was extremely concerned about.  She told me that their facility offered an new technology used diagnostically for women with dense breast tissue.  It is called Contrast Enhanced Spectrum Mammography (CESM) and is only offered at 10 facilities in the country.  I was given an iodine contrast via IV.  It takes 2 images of each breast, one image like a normal mammogram.  On the mammogram with dense tissue, the image looks very bright and busy.  The second image taken, hides all the bright, normal, busy tissue (they call it "noise") and only highlights the abnormal areas.  After the second image was taken, the 2 masses lit up like a light bulb.  It was amazing to see it.  I went from the imaging to ultrasound where the biopsy was done and the radiologist called me 3 days later with the results.  CESM costs much less than an MRI and doesn't require a precert from ins. co.  For me, I feel like this test saved my life.  Who knows how long it would have been before these masses would have showed on the mammogram or developed enough to be felt.  Check it out, it may help.

Hi Farmerlucy,

Precert or precertification is an authorization that is given by your insurance company that allows certain testing to be done.  It is usually required for the more expensive tests...MRIs, CT Scans, PET Scans, etc.  The ordering dr's. office calls the ins. co. and gets the precert by providing the reason the test is being ordered, clinical notes, etc., and sometimes the ins. co. insists on speaking with the dr.  As far as how much the test is, I don't know.  The radiologist who did mine told me that it was much cheaper than an MRI and didn't require a precert so I never asked.  This is relatively new technology and sometimes ins. co. won't pay for it initially so when she told me that my ins. co. would pay for it, I didn't question it.  The test is done similar to a regular mammogram except that they administer an iodine contrast via an IV.  The test is done using the regular mammogram equipment but it has this Contrast Enhanced Spectrum Mammography technology.  Two images are taken of each breast and are viewed side by side on the screen.  One is identical to a mammogram and the second one is done using the CESM technology which eliminates all the bright, dense tissue that you see on a mammogram image and only shows the abnormal areas.  The test took about 10 minutes to do. I live in NJ and had my testing done at the MD Anderson Cancer Center at Cooper in Voorhees, NJ.  If you google CESM or Contrast Enhanced Spectrum Mammography, it should give you the link to their site which has a lot of info including where the testing is being done. The technology is made by GE.  I wanted to share this new diagnostic tool because I truly believe that my cancer wouldn't have been caught for years if I hadn't had this testing done.  Good luck and keep in touch.

Crazy, it's so frustrating when you know something just isn't right. But they are Dr.'s so they know best, so they think!! My regular Dr. didn't even know what an Integrative Oncologist was, ans was questioning some of the things he had me using. My next visit she was all 'Oh just keep doing what he said to do". I think she either got in touch with him or researched it. She totally changed her tune.

I think that those of us that have dense breasts, have to rely on more than one type screening. Unfortunately. It has to be a combination to get a truer picture.

Hi Shira,

It is now a law that radiologists who read mammograms must give a breast density score in the report. I wish that was in place all the years prior to my being diagnosed. Also, google contrast enhanced spectrum mammography and read about this amazing new technology that has been developed by GE specifically used in addition to mammograms for women who have very dense breast tissue. I truly believe that this saved my life because my masses were never picked up on mammograms. Ultrasound showed that there was something there, but CESM is what confirmed that there was a problem.