Breast Density Plays Major Role in Cancer Screening

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Nearly 40,000 American women run the risk of dying from breast cancer annually due to breast density.

“Knowledge is power when it comes to your health,” said radiologist at Baptist Health Breast Center, Dr. Cristina Vieira.

Breast radiologist at the University of Miami Sylvester Comprehensive Cancer Center, Dr. Monica Yepes also explained that when reading a mammogram a radiologist can determine the density of the breasts. The more fibro-glandular tissue than fatty tissue, the denser the breasts are.

Radiologists then rate breast density on a scale of one (least dense) to four (most dense) using the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology.breast density

Typically, most women find themselves at a three or four on the breast density scale, but Yepes assures that this is normal; as breast density fluctuates overtime by several factors such as hormone replacement therapy, or large amounts of weight gain or loss.

However, physicians are aware dense breasts don’t always equate to breast cancer.

Chief of Women’s Imagine for Radiology Associates of Florida, Dr. Mary Hayes mentions that if two patients are similar but one has denser breasts, both patients will respond the same way to the cancer. The only difference lies in detecting cancer in dense breast tissue.

On a mammogram, fatty breast tissue is displayed in gray or black, while fibro-glandular tissues as well as many cancers appear white.

“So detecting a cancer among the dense tissue is like looking for a snowball in a snowstorm or the stars in the daytime sky,” said Hayes.

While mammographies are the current standard for detecting breast cancer, Hayes considers other alternatives such as 3-D mammography or tomosynthesis as better-suited tools for detecting breast cancer in denser tissue.

“The machine looks much like the one used for traditional mammography but instead of taking one picture, it produces an image that resembles the pages of a book. Each ‘page’ represents a one millimeter thickness of your compressed breast. If there is any dense breast tissue or other features that are causing the potential cancer to hide, we can unravel them,” said Hayes.

Hayes also notes that with the 3D technology false positives (number of times women are recalled to check on somethings that ends up as benign) reduced by 20 percent.

“A mammogram gives doctors a picture of the overall appearance of the breasts that can be compared from year to year. The 3-D image on the other hand lets them drill down and look millimeter by millimeter, page by page through that breast,” said Hayes.

Yet it is by no means an attempt to remove standard mammograms, as both technologies can be utilized in complementary fashion.

After receiving a mammogram and tomosynthesis a patient and physician can discuss their breast density and take the appropriate steps in terms of the patient’s age, family, and medical histories.

Women have already launched groups such as How Dense Are you (areyoudense.org), as they strive to pass state and legislation requiring women to be given more information about dense breasts in the letter, notifying them of the results of their mammograms.

However, Yepes notes the call for legislation is unnecessary if women took responsibility for their health and instigated a discussion about breast density with their doctor.

“Together we can weigh the pros and cons,” she said.


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