Your Breast Density Matters

Screening for breast cancer works best when the right people get the right test. 

Otherwise, screening, or looking for trouble, may result in just that: unnecessary trouble that could be avoided.

For example, a woman with dense breast tissue may get a false sense of security with a ‘normal’ mammography report. This is the kind of trouble that can be avoided. 

While mammograms have their use as a diagnostic tool, they also have limitations when it comes to mass screening. Specifically when it comes to the use of mammography for women who have dense breast tissue.

What is dense breast tissue?

Dense breast tissue is rated by a scale known as BRAIDS and has been used by radiologists for over two decades. There are four (4) categories in this scale ranging from 1 to 4, where 1 being low rate – fatty composition to 4 being extremely dense. As the density of BRAIDS scale increases the sensitivity of a mammogram decreases. 

This is the reason why mammography testing in younger women or women with dense breast tissue is not appropriate or even effective. Dense breast tissue has less fat and contains more connective and glandular tissue that displays white on mammographic x-ray; cancerous tumors appear white on an x-ray just as well. 

Thus cancerous tumors hidden by dense tissue can be undetected for many years leading to poor survival outcomes. Further, although most mammography reports will contain BRAIDS rating, yet this important information is seldom shared with the patient by her doctor.

It is important that women know their breast tissue composition. With this information, along with other risk factors, discuss with her healthcare providers the most appropriate testing to assess her breast health. 

It is estimated that up to 40 percent of women who have regular mammograms have dense breast tissue. Thus a ‘normal’ mammography report may be anything but normal as cancer may be hidden by dense tissue. It is not uncommon to get advanced stage III cancer diagnosis within weeks of a normal mammogram.  Although many doctors are aware that mammography’s accuracy is compromised when it comes to dense breast tissue, most do not share this information with women. 

What is the right approach for women with dense breast tissue?

MRI and Ultrasound are more sensitive to finding cancers in women with dense breast tissue that are invisible on a mammogram.  Also women with fibrocystic condition, as I have described earlier in my previous article Fibrocystic Breast Condition need ultrasound testing as it is more specific to cysts and nodules versus a mammogram. 

As with all tests, there are benefits and risks. High rate of false positives with ultrasound and MRI become problematic when suspicious findings lead directly to biopsy. 

Breast thermography can play a great role in evaluating the overall risk. Breast thermography is a non-invasive functional testing of heat patterns in the breast. Thermography provides an early warning signal if there is something going on at the very early stage of development. Women with dense breast tissue should be evaluated with breast thermography and when appropriate should be followed up with an ultrasound. Women need to be informed of the risks and benefits of mammography screening and dense breast tissue, including its impact, on delayed diagnoses and advanced cancer. 

It is time to tailor your breast cancer screening to suit your own specific needs and requirements.