Breast Density – What You Need To Know

Breast density is in the news a lot these days – just what is all the fuss about? Let’s review the facts about breast density and your breast health:

What is breast density?

• Breast density is a description of the makeup of your breast tissue and its appearance on mammography.
• Breasts contain fat (dark gray on a mammogram), varying amounts of glandular tissue (white) and supporting structures (linear white).
• Breast density may vary based on hormonal changes.

Why does breast density matter?

• The more glandular tissue, the harder your mammogram is to interpret!
• Breast cancers often appear as white, star-shaped masses or may appear as tiny flecks of white.
• It is much harder to find a small white mass or speck of white on a background of white tissue than it is on a background of dark gray.
• Further, studies have shown that for those women with the densest breast tissue, there is a slight, probably around 4% increase in the risk of breast cancer.

How do I know what my breast density is?

• Breast density is determined by your radiologist from your breast imaging.
• You cannot determine breast density from a physical breast exam- either by you or your doctor!
• Your breast density will be classified on your mammogram report as:
  • Fatty (10% of women)
  • Scattered fibroglandular tissue (40% of women) – meaning a mix with around 25-50% of the breast being glandular or white mammographically
  • Heterogeneously dense (40% of women) – meaning a mix with 50-75% of the breast glandular
  • Extremely dense (10% of women) – meaning over 75% glandular
• Breasts with density in the last two categories are considered dense.
• As breast density increases, the mammogram becomes progressively whiter.

Where do I find out my breast density?

• Many states have passed laws requiring the reports we give to you include information on your breast density.
• We have been providing information on breast density to our patients for the past few years along with the results we provide before you leave our office.
• If your facility does not provide this information to you, your doctor’s mammography report should contain a statement on breast density.

What should I do now?

• Knowledge is power. Breast density is just one factor which influences breast health.
• If you have no other risk factors for breast cancer other than being female and being over the age of 40, screening with annual mammography and careful clinical breast exams every year will likely be all you need. 3D mammography would be beneficial. Be compulsive and come for that mammogram every 12 months!
• If you are at higher risk for breast cancer due to family history of breast or ovarian cancer or from other factors like radiation to the chest, additional screening tests may be helpful.
• Consulting with your doctor or with a genetic counselor can help determine your individual risk for breast cancer.
• For those with a lifetime risk of over 20%, breast screening should consist of mammography and breast MRI every year, alternating each test every 6 months.
• If your risk is less than 20% or if you are unable to tolerate MRI, screening with breast ultrasound in addition to mammography is an alternative.

No matter your breast density, remember this: mammography saves lives. Make sure you and all those you love get the screening they need.

Dr. Harrison Will Be Taking Your Calls on Dr. Mirabile’s Radio Show!

Great news! Our very own Dr. Linda Harrison will be the guest on Dr. James Mirabile’s radio show tomorrow, July 25th from 1-2p on KCMO Talk Radio (710 AM / 103.7 FM). We’re very excited about this!

Dr. Harrison will be fielding questions from callers and talking about dense breast tissue and – this is important – 3D mammography, the latest advancement in women’s breast health.

Please tune in! Please ask questions! Please have a wonderful weekend and take good care of yourself!

You can listen live here.

Submit your questions online here.

Improving Mammography to 3D Images – No Special Glasses Required

Two years ago, we reported on the emerging technology of 3D mammography. Research since that time has helped to define the benefits and clarify the role of 3D mammography in breast cancer screening.

If you’re wondering how 3D mammography (also called tomosynthesis) works, we have answers. While the machinery will look much like a traditional mammography machine, you will notice a difference when the images are taken. The upper part of the machine will move in an arc while taking several images of the breast tissue. The latest machines approved for 3D mammography can do a 3D study with the same radiation dose as a conventional 2D mammogram, unlike some earlier versions. This is still a mammogram, and yes, compression is still required.

Computers are used to take the digital data obtained from those multiple mini-exposures and convert it into multiple thin, 1 mm or less slices through the breast tissue. The 3D part is done in the radiologist’s head – no special glasses required! The benefit to the radiologist is that the tissue of the breast can be seen without overlap. Think of trying to look through the pages of a book as a whole, versus looking at one page of a book at a time – this is sort of the difference between a 2D mammogram where all the tissue overlaps versus a 3D mammogram where it can be separated.

So what is gained with 3D mammography? There are two important benefits: first, 3D mammography allows the radiologist to find more cancers. Are we excited to find more cancer? No, but… the benefits of early detection are astounding, skyrocketing survival rates. If we can catch cancer early, we can literally save lives. We don’t dance for joy when we discover cancer, but we dance when we know our patient will live.

The other big benefit is the need for fewer work-up studies, especially diagnostic mammograms following a screening study,  because we are able to view the tissue without overlap. The need for additional testing is reduced, thus saving time, cost and anxiety.

While research has shown consistently positive results in the number of cancers found and the reduction in the need for additional testing, the precise role of 3D mammography is still under investigation. Further, most payors are not covering the additional cost of 3D mammography.

More breast cancers are found in women with all breast densities, but those with dense breast tissue will likely benefit the most. Other groups we think will benefit the most include women with a history of breast cancer, family history of breast cancer, women with previous inconclusive mammograms and women with prior breast cysts or lumps.

In short, 3D mammography is proving to be a very valuable tool for breast cancer screening and detection.

(Image credit: 3D-Glasses by xenmate via Flickr. Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

Breast Density: Who Knows? We Do! (And So Should You)

As doctors, medical terminology is an integral part of our workday, but we realize not everyone has familiarity with those crazy Latin roots or the phrases that we use and re-use! However, there are some medical words and phrases that it would behoove you to know.

“Breast density” is one such term. Every mammography report includes a statement about it, and all women should have an understanding of what it means. However, according to a new study, nearly half of all women who should be getting mammograms had never heard of breast density. Yikes – there is room for more education here!.

Breast density is not something that can be discovered by a physical breast exam, either your own self-exam or your doctor’s clinical breast exam. Mammography reveals the internal structures of the breast with an image of varying shades of black, gray and white depending on the relative amounts of fat and glandular tissue. Breast density is described on a scale from fatty breasts to dense breasts. A fatty breast is one where most of the tissue has been replaced by fat with the image mostly dark gray. A dense breast on the other hand has mostly glandular tissue and will appear as mostly white. Many breasts fall somewhere in the middle.

Cancers often appear as white on a mammogram, whether a mass or tiny microcalcifications. One of the important reasons you should know about breast density is dense breasts make it harder to find some breast cancers on a mammogram. Simply put, it is harder to find a small white object (a potential cancer) on a background of white seen on a dense mammogram.

The other important reason you should know about your breast density is the small but real increase in the risk of breast cancer in those women with dense breasts. This is on the order of a 3-4% increase.

Here’s what YOU can do:

• Doctors are only required to disclose if you have dense tissue in a handful of states. If you are not in one of those states you can still find out your breast density from the report or discussion with your doctor and/or radiologist.

• If you have dense breasts, knowing your other risk factors is important. If this is your only other risk factor for breast cancer (other than being female!), routine annual screening with mammography may be all you need. Getting that mammogram every year is important to assess for changes!

• If you have other risk factors in addition to dense breasts, supplemental imaging may be a good idea. This can include breast MRI for those with high risk (for example having a mother or sister with premenopausal breast or ovarian cancer) or breast ultrasound if intermediate in risk.

As the saying goes, knowledge is power. And knowing if you have dense breasts (and what to do about it) can save your life – that’s really powerful!

(Image credit: Question Mark by Leo Reynolds via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0))

Top 10 Questions About Mammography

1. Why can’t I wear deodorant?

One of the signs we are looking for in every mammogram is tiny flecks of calcium, which can be a finding of early breast cancer. Deodorants and antiperspirants contain metals which can look just like those little flecks of calcium. The same is true with sparkly lotions and some powders. Avoid those on the day of your mammogram to make life easier for you and your radiologist!

2. Why do you have to compress (squeeze!) the breasts?

Approximately ten (10!) seconds of compression is a key part of every mammogram –even the 3D mammogram- for several reasons. The two most important reasons are these:  First, compression prevents motion which can cause blurring and obscure findings in the breast tissue. Additionally, compression is a key way of separating normal breast tissue which compresses easily from cancers which are stiff and do not compress. Though not the most comfortable thing, it is key to getting a quality mammogram!

 

3. Why do I have to bring my old breast imaging studies?

Having your old studies to compare to your current is a key way of making sure your breast tissue is normal. Every breast is unique; there are a lot of benign, non-cancerous things that can be present in your breasts, like lymph nodes, calcifications, big vessels. If we have your old images, we will know what is normal for you. Without them we may have to do further work-ups.

 

4. What does it mean if I have dense breasts?

The more breast tissue and the less breast fat means a dense breast. This is important for two reasons: the first, dense breast tissue is harder to interpret by mammography – it’s not as easy to see some cancers due to the background tissue. Second, there is a slight increase in the risk for breast cancer when your breast density falls in the most dense category. What should you do? Ask your doctor to find out if you have dense tissue. Make sure you have your annual mammogram and clinical breast exam without fail. Talk with your doctor if you have other risk factors for breast cancer to see if any additional imaging is warranted. Remember – dense tissue is merely a trait and may occur in women of all shapes, sizes and ages.

5. Can I have a mammogram if I have breast implants? Will the implants rupture?

Women with implants should have their annual screening mammogram. You are at much more risk of developing breast cancer than you are at risk of having a complication with your implant. In doing a mammogram on a woman with implants, we are careful to apply only slight compression on the breast with the implant in place. Additional images are then taken with compression of the breast tissue with the implant gently moved out of the way.

6. When should I start getting a mammogram?

For women of average risk (no family history or history of chest radiation), begin yearly screening mammograms at the age of 40.

7. When should I stop having mammograms?

This is harder to give a firm answer to, but annual mammography will still find smaller, more easily treated breast cancers even in women in their 80s. If you are healthy and would undergo treatment if a breast cancer were to be found, continue those annual mammograms!

8. Do I really need a mammogram every year?

Yes!

9. I don’t really need a mammogram, do I, because:

• I have small breasts
• I have no family history
• I feel perfectly healthy
• I have no lumps
• My doctor didn’t tell me to…

 

Guess what? Absolutely none of the above “reasons” should sway you from having an annual mammogram. Cancer can be seen on mammography before it can be felt (yay mammography!) and occurs in women with no family history (upwards of 80% of the time!).

 

And if your doctor didn’t tell you to… they may assume you already know to take care of yourself, especially since no doctor’s order is required for a screening mammogram!

10. Do you really like what you do (uttered every so often to our mammography technologists and sometimes to us!)?

The answer is yes – we really do. Don’t call us weird – call us weirdly caring. We do what we’re good at, we do what we feel passionately about in order to help. We do what we do because even if it means inflicting the occasional squish on a fellow woman, we know that together we can make a difference in the fight against breast cancer. Who wouldn’t love that?

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

3D Mammography: A work in progress

Source Dr. Kathy Cho. NIH Radiology; License: Public Domain

There is a new mammogram technology that has been coming into the market to augment the current digital mammograms: breast tomosynthesis, otherwise known as 3D mammography.

This is a 3D mammogram technique, still using compression and radiation but with images obtained in an arc and then reconstructed into thinner slices. Three-dimensional mammograms are still “young” – research is on-going as to its strengths and limitations.  The breast imaging community is still learning how this technique will be best utilized – who should get them and when is still in question.  What is known about them is this: They seem to be able to separate out areas of normal tissue and potential masses better. Dense breasts still can be an issue as with routine digital mammography.  Breast microcalcifications are often better evaluated on routine digital mammography studies. One machine is currently approved for clinical use, and that system is approved only as used with 2 sets of tomosynthesis and the standard 4 mammogram views – resulting in higher radiation doses.

Many more images are taken with this kind of mammography, meaning a tremendous amount of information to be read, compared, and stored. Developing ways of managing the multiple images for this year – and your future years of breast imaging is still being worked out.

The equipment for 3D mammography is making its way into more hospitals and offices, although the machinery is expensive and the test is seldom covered by insurance companies.

So, we believe research will work out which women are going to benefit most from this type of imaging – either in a screening role, or for problem solving. The most important thing to remember is this: annual screening mammograms are still vital to saving women’s lives.