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Dense breasts can make it harder to spot cancer on a mammogram

Dense breasts can make it harder to spot cancer on a mammogram
So dense breast is based on the mammogram images of your breast, which is basically an x-ray of your breast. On one end of the spectrum, we have patients who have predominantly fatty breasts and on the other end of the spectrum, we have patients who have predominantly glandular breasts. This is an example of *** mammogram of *** left breast and *** patient who has predominantly fatty breasts. And as you can see the background is black. And if we if she were to develop any masses, um they would be like uh *** beacon like *** white, *** chalk on, on, on *** blackboard. This is an example of *** dense breast. And as you can see the background on this X ray is very white. Uh So you can imagine um if you were to start to grow *** small mass which is also white, it could be lost in this type of uh mammogram. So for people with dense breasts, we often, you know, uh advise them to get additional imaging. I just assumed that it just meant I had like heavier breast tissue perhaps. Um But then when I kind of like research and they would educate me about it. It's like it is harder to kind of see things in dense breast tissue. But when you get the information that many women have dense breasts and it just warrants additional testing. Dense breasts doesn't mean, you know, you're going to get cancer. It just means it's harder to see or detect it. If there is something, if there is *** tumor, there, there's *** malignancy. So this is giving us the added benefit of being able to see that mammogram is the gold standard for detecting breast cancer. And for saving lives early, we use that as our foundation when we're, you know, imaging women's breasts and we work off of the mammogram. So even though, you know, like I said, it may hide small masses, other things we look for are microcalcifications, we look for distortion in the pattern. So there are other things that we will see on *** mammogram even in *** patient with dense breasts. And that is where you always wanna start.
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Dense breasts can make it harder to spot cancer on a mammogram
When a woman has a mammogram, the most important finding is whether there's any sign of breast cancer.The second most important finding is whether her breasts are dense.Since early September, a new U.S. rule requires mammography centers to inform women about their breast density — information that isn't entirely new for some women because many states already had similar requirements.Here's what to know about why breast density is important.Are dense breasts bad?No, dense breasts are not bad. In fact, they're quite normal. About 40% of women ages 40 and older have dense breasts.Women of all shapes and sizes can have dense breasts. It has nothing to do with breast firmness. And it only matters in the world of breast cancer screening, said Dr. Ethan Cohen of MD Anderson Cancer Center in Houston.With the new rule, "there are going to be a lot of questions to a lot of doctors and there's going to be a lot of Googling, which is OK. But we want to make sure that people don't panic," Cohen said.How is breast density determined?Doctors who review mammograms have a system for classifying breast density.There are four categories. The least dense category means the breasts are almost all fatty tissue. The most dense category means the breasts are mostly glandular and fibrous tissue.Breasts are considered dense in two of the four categories: "heterogeneously dense" or "extremely dense." The other two categories are considered not dense.Dr. Brian Dontchos of the Seattle-based Fred Hutchinson Cancer Center said the classification can vary depending on the doctor reading the mammogram "because it's somewhat subjective."Why am I being told I have dense breasts?Two reasons: For one, dense breasts make it more difficult to see cancer on an X-ray image, which is what a mammogram is."The dense tissue looks white on a mammogram and cancer also looks white on a mammogram," said Dr. Wendie Berg of the University of Pittsburgh School of Medicine and chief scientific adviser to DenseBreast-info.org. "It's like trying to see a snowball in a blizzard."Second, women with dense breast tissue are at a slightly higher risk of developing breast cancer because cancers are more likely to arise in glandular and fibrous tissue.Reassuringly, women with dense breasts are no more likely to die from breast cancer compared to other women.What am I supposed to do?If you find out you have dense breasts, talk to your doctor about your family history of breast cancer and whether you should have additional screening with ultrasound or MRI, said Dr. Georgia Spear of Endeavor Health/NorthShore University Health System in the Chicago area.Researchers are studying better ways to detect cancer in women with dense breasts. So far, there's not enough evidence for a broad recommendation for additional screening. The U.S. Preventive Services Task Force called for more research in this area when it updated its breast cancer screening recommendations earlier this year.Do I still need a mammogram?Yes, women with dense breasts should get regular mammograms, which is still the gold standard for finding cancer early. Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk."We don't want to replace the mammogram," Spear said. "We want to add to it by adding a specific other test."Will insurance cover additional screening?For now, that depends on your insurance, although a bill has been introduced in Congress to require insurers to cover additional screening for women with dense breasts.Additional screening can be expensive — from $250 to $1,000 out of pocket, so that's a barrier for many women."Every woman should have equal opportunity to have their cancer found early when it's easily treated," Berg said. "That's the bottom line."

When a woman has a mammogram, the most important finding is whether there's any sign of breast cancer.

The second most important finding is whether her breasts are dense.

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Since early September, a new U.S. rule requires mammography centers to inform women about their breast density — information that isn't entirely new for some women because many states already had similar requirements.

Here's what to know about why breast density is important.

Are dense breasts bad?

No, dense breasts are not bad. In fact, they're quite normal. About 40% of women ages 40 and older have dense breasts.

Women of all shapes and sizes can have dense breasts. It has nothing to do with breast firmness. And it only matters in the world of breast cancer screening, said Dr. Ethan Cohen of MD Anderson Cancer Center in Houston.

With the new rule, "there are going to be a lot of questions to a lot of doctors and there's going to be a lot of Googling, which is OK. But we want to make sure that people don't panic," Cohen said.

How is breast density determined?

Doctors who review mammograms have a system for classifying breast density.

There are four categories. The least dense category means the breasts are almost all fatty tissue. The most dense category means the breasts are mostly glandular and fibrous tissue.

Breasts are considered dense in two of the four categories: "heterogeneously dense" or "extremely dense." The other two categories are considered not dense.

Dr. Brian Dontchos of the Seattle-based Fred Hutchinson Cancer Center said the classification can vary depending on the doctor reading the mammogram "because it's somewhat subjective."

Why am I being told I have dense breasts?

Two reasons: For one, dense breasts make it more difficult to see cancer on an X-ray image, which is what a mammogram is.

"The dense tissue looks white on a mammogram and cancer also looks white on a mammogram," said Dr. Wendie Berg of the University of Pittsburgh School of Medicine and chief scientific adviser to DenseBreast-info.org. "It's like trying to see a snowball in a blizzard."

Second, women with dense breast tissue are at a slightly higher risk of developing breast cancer because cancers are more likely to arise in glandular and fibrous tissue.

Reassuringly, women with dense breasts are no more likely to die from breast cancer compared to other women.

What am I supposed to do?

If you find out you have dense breasts, talk to your doctor about your family history of breast cancer and whether you should have additional screening with ultrasound or MRI, said Dr. Georgia Spear of Endeavor Health/NorthShore University Health System in the Chicago area.

Researchers are studying better ways to detect cancer in women with dense breasts. So far, there's not enough evidence for a broad recommendation for additional screening. The U.S. Preventive Services Task Force called for more research in this area when it updated its breast cancer screening recommendations earlier this year.

Do I still need a mammogram?

Yes, women with dense breasts should get regular mammograms, which is still the gold standard for finding cancer early. Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk.

"We don't want to replace the mammogram," Spear said. "We want to add to it by adding a specific other test."

Will insurance cover additional screening?

For now, that depends on your insurance, although a bill has been introduced in Congress to require insurers to cover additional screening for women with dense breasts.

Additional screening can be expensive — from $250 to $1,000 out of pocket, so that's a barrier for many women.

"Every woman should have equal opportunity to have their cancer found early when it's easily treated," Berg said. "That's the bottom line."