Are Dense Breasts High Risk?

Leaf, I learned quite a bit from your comments in particular throughout this discussion; thanks. (PRIOR TO having bc I thought I was reasonably educated also.)

I was premeno at dx at age 51. In observing the series of mammograms I had from 2 years prior to dx to those after treatment with tamoxifen, there was a major difference in the density in just 3 months of taking it. I'm not advocating taking the drug, just making a personal observation.

I too firmly believe that those with especially dense breasts should have the right to MRI as well as mammogram and ultrasound. I think that at the very minimum (even as controversial as testing accuracy may be), a CA 25.29 or CA 15-3 should be done and if that is at all abnormal then either a repeat CA 25.29 or CA 15-3 could be done and if that continues to be abnormal then the MRI should be done. Maybe that would be a way to start proving the benefit and achieving the goal of MRI's routinely for dense breasts.

Hi there,

I was told I have dense breast . I have mamo in March came back clear. I  started  excising and watching my weight. After I lost about 30 lbs I found a lump in my breast, I had another mamo it still did not show. I then had a utlrta sound it finally showed then.

I was 3 cm they told me women with dense breast sometimes the lump it there for 6-8 yrs before it is found.

I was at the cancer center and was reading an article in the Living with cancer magazine. Here is what it said

You have young estrogen -rich breast and are at a higher risk for BC. Breast are made up of fatty tissue, tissue in the milk duct and other structures is noticeably denser.Younger  and leaner women have a higher dense tissue so do post menopausal women on hormone replacement therapy.

On xrays dense breast appears white. Unfortunately so does cancer. This means if a small tumor appears in your breast it may be hard for a radiologist to spot it on a mamo. It said having dense breast raised your risk of BC at least threefold.

It advised women with dense breast to seek out a facility that uses digital mammography rather than traditional film technology.

Digital mammography is better at assessing dense breast tissue because the radiologist can enlarge the image and lighte  or darken the background making it easier to find.

I just saw an article in the Annals on Internal Medicine about a different breast cancer risk model that includes breast density. (4 March 2008, 148(5), 337).





In this article, it opines that 2 other risk assessment models have incorporated mammo breast density: a) a refinement of the Gail model by Chen et al, which used a continuous measure of breast density, and b) a model by Barlow et al used BIRADS as its measure of breast density. It points out that Chen et al's model has not been compared to different populations, and uses a continuous measure of breast density that is not available in clinical practice because it required digital scanning of the mammogram and specialized software to estimate density, a relatively labor intensive process. The Barlow et al model focused on a 1 yr risk for breast cancer and was validated on the cases of bc diagnosed by the initial mammo. The Barlow model may overestimate a woman's lifetime risk by including incident cancers detected by the first mammo.





This model was based on 1,095,484 women undergoing mammography who had no previous diagnosis of breast cancer. They used self reported age, race or ethnicity, family history of breast cancer, and history of breast biopsy. It had a 5.3 year followup.





This model used BIRADS as a measure of breast density, which had a modest reproducibility (kappa =0.72, 83% agreement) and interobserver variability was modest (kappa=0.59, 75% agreement).





Results: Compared to the Gail model, this breast density model reclassified a larger percentage of women incorrectly than correctly. It reclassified a higher portion of women who developed bc into higher risk categories. It says this can happen when 1 of the models is not well calibrated. It says the Gail model has recently been shown to underestimate the risk of invasive bc for black women by a factor of 1.5-3.2.





It was well calibrated in major race and ethnicity groups in the US. But it should be further evaluated in independent populations.





The model overall had a discriminatory accuracy of 0.66, which when adjusted for age (the strongest risk factor for breast cancer) it was even lower (0.622). (In another paper, the Gail and Italian model, which incorporated breast density, had a correlation value of about 0.59). What this means in real terms is that in this model, a random individual woman with breast cancer was assigned a higher risk than a random individual person without breast cancer 66% of the time. It also means that 34% of the time the woman without breast cancer was assigned a higher risk than the person with breast cancer. (This was categorized as a 'modest ability to discriminate between women who will develop breast cancer and those who will not.')





It says that factors that have extremely high relative risks (>100) are required for risk factor models to have high discriminatory accuracy.





It concludes its accuracy needs to be further evaluated before it can be recommended for clinical use.





Well, I'm glad they're trying.

A huge study came out from Princess Margaret Hospital in Toronto ( one of the top five cancer hospitals in the world) in Jan. 2007 showing that dense breasted women are 6 x more likely to get breast cancer.

I am telling every dense breasted woman I know to demand a breast MRI, this is the only test that can really show any tumours.  I had a mammogram and breast ultrasound in June 2006, showing nothing.  I went in for a breast reduction 4 months later and my PS found my tumour.  Shock of shocks. No family history, I exercised, was in otherwise good health.  Then I had a breast MRI before my mastectomy and it showed another 1 cm. tumour in the right breast again, which was coming off anyways.

Your breasts can be tiny and dense, big and dense or not dense at all. Apparently density does abate after menopause. Your report from the radiologist from your mammo, (and try to get a digital mammo, the usual ones are totally useless on dense breasts) will note your breast density.  Demand the breast MRI if this report notes density. 

I, too, am a post-menopausal woman with dense breast tissue. (Beesie and I could make a pair, since I lost my left breast last month to IDC.)

My 1.8 cm IDC was never detected with mammography--not even the digital mammogram I had at the breast clinic at a comprehensive cancer center.  The radiologist reading that mammogram knew there was a palpable lump, but there was no sign of it amongst the radiographic "clutter" of my dense tissue.  OTOH, the cancerous lump was easily seen with ultrasound and its malignant character (high vascularity) was unmistakable with contrast MRI.  That is not true for all malignant tumors, though.

My surgical oncologist and radiation oncologist told me I would probably need to have US in addition to mammography for the rest of my life. Unfortunately, I will probably never have a true "early" diagnosis in my remaining breast, because the subtle calcification that frequently occurs with early BC won't be detectable.

Still, it's good to know (finally) that my dense tissue means I need to be more vigilant about screening and more assertive about follow-up.  Not only does dense breast tissue make it more difficult to see the early changes caused by BC, but dense breast tissue is inherently more prone to the development of BC.

otter

[Edited to add that I have never taken hormone replacement therapy, so that's not why my breast tissue remains dense.] 

Well, this abstract talks about the features of mammography with DCIS. http://www.ncbi.nlm.nih.gov/pubmed/15797293?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA



This abstract talks about their experience of DCIS with US. http://www.ncbi.nlm.nih.gov/pubmed/17891529?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum



and here's another with microcalcs with a Birads score of 4A. http://www.ncbi.nlm.nih.gov/pubmed/17703906?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum



And this paper of women 30-39yo liked mammos better than US for DCIS. http://www.ncbi.nlm.nih.gov/pubmed/17703906?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum



I don't know if these papers represent the general consensus or not. They also do not answer the question if DCIS in women with dense breasts is better detected by mammo or MRI vs ultrasound.
So I really haven't answered your question.

dense breasts do put you at higher risk and it is much harder to dx bc in dense breast tissue- i have been told since i am a teenager that i had dense breast tissue-  at 39 i felt a lump- took a mammography and even though i could feel the lump the mammo showed nothing abnormal so had i not felt it myself it would have gone unnoticed for another year- 10 yrs later- i was told if anything ever came up again that we would catch it early since i was having mammo and sono and being watched carefully - well a shock to me but i felt a lump right before my mammo and mammo again showed nothing (tumor was over 6cm(HOW IS THAT POSSIBLE FOR A MAMMO TO MISS SUCH A LARGE TUMOR???)i should have been having MRI's my breasts did not get less dense with age and now at 50 i had a dbl mast and reconstruction i always try and stress to women  especially young women with dense breasts that mammo is not the end all

digital mammo or MRI with sonograms is the way to go

xoxoxo

Hi i had my routine mammo in Oct 07 and they told me that i had a small lymph node told me to come back in 6 mos which i did last week they did a mammo and sono the report is normal no malignancy, the dr suggested i have a mri because my breast are so dense so i did that and needless to say they screwed them up the pic couldnt be read because of a computer error now they want me to come back. I dont want to go through that again if my report from mammo and sono are normal and I am going to my dr this afternoon to have him do a breast exam do you think I really need the mri again what is your opinion.  Stressed out over all this crap

I'd agree with those that say get an MRI.  I had a mammogram in August that missed FOUR tumors in the same breast!  I could feel two of them by December, and just had a mastectomy.  When I strongly complained to my surgeon about the mammogram having missed them (twice - they called me back to do the affected breast again, then said it was OK), she said that I had very dense breasts.  If you have dense breasts, make sure you get at least a diagnostic mammogram, a sonogram, or best yet, an MRI.

Ladies, Ladies!!!

Ya gotta see this video

You can see it on Youtube or click on the link for Wake Radiology

Breast MRI: From the Patient Perspective 

http://www.wakeradiology.com/ForPatients/EducationalResources/BreastMRIFromthePatientPerspectiveFLVHi/tabid/402/Default.aspx 

While waiting on my mri results, I've been thinking a little more about my risk factor. I wondered if I should have just gotten a simple mammogram. But after reading the article, I'm about to post here, I'm glad I did. Dense breast need special attention as cancer can hide in dense breast...plus having other risk factors. Actually, about 6 months ago, I ask my doctor to schedule me a mri, especially after what I learned on the boards about dense breasts.