Understanding Screening for Dense Breasts
- Famous TV presenter Julia Bradbury, whose breast cancer was missed twice before she was diagnosed in 2020, is crediting the life-saving ultrasound she underwent that detected a 6cm tumor in her left breast. She underwent a double mastectomy and surgery to remove the tumor after learning she had cancer. She’s now in remission.
- Breast density is a radiographic diagnosis that can only be determined with mammography. However, when it comes to testing women with dense breasts for cancer, mammography may need to be used with other screening methods, like an ultrasound, which found Bradbury’s tumor in her breast.
- Women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening.
- While mammograms are extremely valuable for breast cancer screening, more effective screening methods exist for women with dense breasts.
3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk. - The U.S. Preventive Services Task Force recommends women begin screening for breast cancer at age 40. Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
Speaking on Good Morning Britain this week, to presenters Susanna Reid and Ed Balls, Bradbury explained, “I’ve got something called dense breasts, which I have to explain because 40 percent of women have dense breasts … it’s nothing to do with the shape or size, it’s to do with your tissue, the density of the tissue and it makes it very difficult to detect cancer on mammograms because dense breasts show up white on a mammogram and cancerous tumours show up white.
Read MoreThe NHS is today launching a huge artificial intelligence trial, aiming to detect breast cancers more quickly and free up radiologists to slash waiting times.
Presenter and campaigner Julia Bradbury who was diagnosed with breast cancer in 2021 and is now in remission, explains… pic.twitter.com/YAZEyNFXz2— Good Morning Britain (@GMB) February 4, 2025
Bradbury explained further, “Well, if it had been missed that third time, then I might not have been here. I might have been going through much more severe treatment now, perhaps.
“You know, your mind races as to what might happen. I wasn’t close to death, but death looked me in the eyes. So I am more focused on my health than I ever have been.”
After admitting to no longer drinking alcohol, eating a healthy diet, and exercising daily, she continued, “When I came home from my mastectomy, I promised I would spend time outside every day, and that is my mantra, however poor it might be in this s***ty winter.”
Helping Patients Better Understand Dense Breasts
- How to Avoid False Positive Cancer Results in Women With Dense Breasts: Ultrasounds Used in Addition To Mammograms
- I Have Dense Breasts. Do I Need a 3D Mammogram?
- When You’re Getting a Mammogram, Ask About Dense Breasts
- Millions of Women With Dense Breasts — A New Congressional Law — What You Need to Know
We love how Bradbury is spreading awareness about screening for dense breasts, especially after the Food and Drug Administration (FDA) announced last year that it is now requiring women undergoing mammograms, which screen for breast cancer, to be notified of their breast density.
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Bradbury also took to Instagram to tell her fans about her interview, by sharing a photo of her topless and her back facing the camera, writing, “For World Cancer Day I want to celebrate all my fellow survivors & thrivers, and pass love & peace to all those we’ve lost along the way.
“A cancer diagnosis takes you to places you never thought existed. But we are shaped by our challenges, not defined by them. Love. Health. Kindness.
#worldcancerday. Tomorrow morning I’ll be on @gmb talking about some exciting advances in AI which will help with screening & early detection of breast cancer.”
Julia Bradbury’s Breast Cancer Journey
Julia Bradbury’s diagnosis came after a couple mammograms to check on a lump she found in her breast during the summer of 2020, when she was 50 years old. She announced her breast cancer diagnosis in September 2021, but she told her husband and children before sharing the news with the world.
“Telling your children you have cancer is the hardest thing you’ll ever have to do in your life,” the BBC host previously said in an emotional interview. “You also don’t quite now how much to tell them to be realistic, and how much do you need to protect them as well. It is a very tricky balance. I don’t think any parent really knows exactly what to do.”
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Bradbury had a double mastectomy to treat her disease shortly after her diagnosis. A mastectomy is the full or partial removal of a breast and it’s used as a treatment for breast cancer. Other breast cancer treatments can include radiation, chemotherapy, and immunotherapy.
Following her mastectomy, she immediately underwent breast reconstruction.
As for where she’s at now, she does not technically have the all-clear yet. In a separate interview, she revealed that she has tiny fragments of cancerous cells in her breast tissue and a genetic predisposition to a higher-than-average risk of her cancer coming back. Even still, her attitude is positive.
“I’m in the top five or six percent of women in the country in terms of the likelihood of recurrence,” she said. “That puts me in the ‘moderate risk’ category higher than the average woman but, look, it’s about percentages and perspectives.
“The doctors have not found a huge spread of an aggressive cancer. I have lost my breast but been able to have an implant and keep my own nipple. I feel lucky and grateful every single day, and I have to learn to live with this risk, to accept the fragility of life, without it consuming me.”
She did not need chemotherapy or radiation to treat her breast cancer, but Bradbury has recently been considering the pros and cons of starting a regime of hormone therapies to reduce her likelihood of recurrence.
“They’re potentially life-saving drugs, but they come with significant side effects for some women joint pain, osteoporosis, trouble with your teeth, risk of uterine cancer and a running jump straight into menopause,” she explained. “I have young children to consider and it’s hard to know what’s best.”
Understanding Your Mammogram Report and Breast Density
A radiologist reading mammograms categorizes breasts into four different categories using the Breast Imaging Reporting and Data System (BI-RADS), a classification system developed by the American College of Radiology (ACR). These include:
- Fatty breast tissue: These breasts are mainly composed of fat with very little dense tissue. Found in less than 10% of women, fatty breasts appear dark on mammograms.
- Scattered fibroglandular breast tissue: These breasts contain a mix of fatty and dense tissue (composed of glands and fibrous tissue). On a mammogram, they have dark areas (fatty tissue) intermixed with light areas (dense tissue). Around 40% of women have breasts that fall in this category.
- Heterogeneously dense breast tissue: This type of breast tissue has many areas of dense tissue and some areas of fat. Found in 40% of women, these breasts look mostly light, with some dark areas on a mammogram.
- Extremely dense breast tissue: Such breasts are almost entirely composed of dense glandular and fibrous connective tissues with very little fat. They are found in 10% of women and appear light on mammograms.
Your breasts are usually called dense on a mammogram report if they fall within the heterogeneously dense breast tissue or the extremely dense breast tissue categories.
WATCH: When You’re Getting a Mammogram, Ask About Dense Breasts
Additional Screening for Dense Breasts
Women with dense breasts may not know they have it based on feeling alone. Breast density is determined by its appearance on a mammogram. Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, explains to SurvivorNet that fatty breast tissue appears gray on an X-ray.
Conversely, dense breast structures appear white during an X-ray. Cancers also appear white on an X-ray, meaning the dense breast structures can mask the possibility of cancer. Luckily, advanced mammograms exist to help doctors navigate this obstacle.
WATCH: 3D Mammograms explained.
“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Lehman explains.
“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.
Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance. These tests include:
- 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
- Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer could justify obtaining breast MRIs.
- Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.
With the help of the FDA’s new rule, facilities offering mammograms will need to inform patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details to share with the patient to make the communication clear and understandable.
WATCH: Breast Cancer Surgeon Lays Out Ways We Can Close the Gap in Racial Disparity.
The Exact Cause Of Dense Breasts In Not Fully Understood
Why certain women are born with dense breasts while others aren’t is not always known. However, it is likely that several factors contribute to a woman’s breast cancer density.
Genetics is a likely contributor to breast density. If women in your family have a history of dense breasts, you are more likely to have similarly dense breast tissue. However, genetics is not the only reason.
Levels of estrogen and progesterone, two hormones that are essential to female health and reproduction, may also influence breast density. Pre-menopausal women who tend to have higher levels of these hormones have denser breasts than post-menopausal women, who have lower hormonal levels. By extension, women who take hormone replacement therapies after menopause may unwittingly increase their breast tissue density.
Age is another determinant of breast density. Younger women tend to have denser breasts than older women. Body weight also impacts density, with women with lower body weight (by extension, low body fat percentage) possessing more dense breasts than those with higher body weight.
Additionally, it’s unknown whether women can directly change their breast density to decrease their risk for cancer.
There is evidence that diet and lifestyle factors influence breast density, with women with more body fat accumulating fat within their breasts, which lowers their breast density.
However, gaining weight just to decrease breast density may be counterproductive. Robust scientific studies have repeatedly shown that maintaining a healthy weight through diet and physical activity lowers the risk of any cancer. Thus, any benefit of a decrease in breast density through an increase in body fat is likely more than offset by the increased risk of cancer associated with being overweight or obese.
The Importance of Breast Cancer Screenings
Mammograms are used to screen for breast cancer. Women who haven’t gone through menopause are encouraged to get a mammogram annually between the ages of 45 and 54. If you have experienced menopause, you can get a mammogram every two years.
The U.S. Preventive Services Task Force recommends women begin screening for breast cancer at age 40. Women should talk with their doctor to learn about their cancer risk and assess when a good time is to start annual mammograms.
WATCH: Understanding the BRCA gene mutation
“We all agree regular screening mammography saves lives,” Dr. Connie Lehman, a professor at Harvard Medical School, told SurvivorNet.
Suppose you fit into the high-risk category for breast cancer, meaning a close family relative has been diagnosed. People at higher risk may have the BRCA1 or BRCA2 gene mutation or had radiation to the chest area when they were young. In cases like this, people in the high-risk category should begin annual mammograms at 30 years old.
Contributing: SurvivorNet Staff
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