Density of tissue can mar image
Q: After my last mammogram, the doctor told me I have dense breasts. Does this increase my risk of breast cancer?
A: A woman's breast contains different types of tissue, including fat. Women with dense breasts have relatively less fat in their breasts. Specifically, if more than 50 percent of your breasts is made up of other breast tissue (as opposed to fat), then by definition you are said to have "dense breasts." It's not uncommon: About 40 percent of women have dense breasts.
Women with dense breasts have a slightly increased chance of developing breast cancer - and dense breasts can make cancer harder to spot. That's because both breast tissue and tumors appear white on a mammogram.
Imagine looking at snowflakes on a black glove. Set against the dark fabric, you can make out some of the crystals in detail. Then, take those same flakes and put them in a bed of snow. Now it becomes difficult to distinguish the flakes from their background. That is the challenge radiologists face when trying to read the mammograms of a woman with dense breasts.
There now is a federal law in the United States that mammogram reports should always explicitly state whether a breast is "dense" or not.
So should you have additional screening tests for breast cancer? The trouble is, no test can diagnose breast cancer with 100 percent accuracy, especially in women with dense breasts. And the additional tests that I'm about to describe pick up a lot of "false positives": The result looks like there might be cancer, requiring a biopsy that shows no cancer. And tests can also be costly.
If you do decide to have further screening, here are some options to consider:
-âUltrasound. In September 2012, the FDA approved a new breast ultrasound system specifically for screening dense breasts. This ultrasound scans the entire breast using high-frequency sound waves and quickly produces several images. If you were going to have additional testing, your doctor most likely will recommend this ultrasound.
-âMagnetic resonance imaging uses magnets and radio waves to visualize the breasts. It would not normally be recommended just because a woman has dense breasts, because of the problem of false-positive results.
-âDigital mammography sends X-ray images of the breast to a computer, rather than to film, making them easier to manipulate and interpret. A large study of nearly 50,000 women concluded that digital mammography was somewhat more accurate than regular film mammography in women with dense breasts.
Talk with your doctor about your overall risk of developing breast cancer. Together, you can determine what screening tests you need and how often.
DR. ANTHONY KOMAROFF is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.askdoctork.com.
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