Being Better Informed About Your Breast Cancer Risk
- Mammogram centers will soon have to tell women if they have dense breasts like Katie Couric, who shared her breast cancer diagnosis in September.
- Having dense breasts means there is a higher amount of glandular and fibrous connective tissue in the breast and a lower amount of fatty breast tissue, according to Cancer.org. This makes it more difficult for a regular mammogram to detect cancer.
- With the new rule from the FDA, there will be “uniform guidance” on what language to use and what details must be shared with the patient.
- Because women cannot feel if they have dense breasts they have to be told after a scan so many more women will be better informed about their own health and cancer risk, allowing them to seek consultation earlier and further testing, if necessary.
- Our experts say to ask about your breast density at your next mammogram, as a 3D mammogram may be needed to more easily detect early signs of cancer.
The new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify a patient about the density of their breast tissue and reccomend 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 must be shared with the patient, so that the communication is clear and understandable.
Read MoreCouric brought important attention to dense breasts while announcing her breast cancer diagnosis in September. She said because of the density, she "routinely gets an additional screening using a breast ultrasound." She also underwent surgery and radiation treatment for her breast cancer.
Women with dense breasts were found to have a "1.2 to 4.0 times higher risk of breast cancer (depending on degree of density) compared with 2.0 times higher risk associated with a first-degree family history of breast cancer,” according to a recent study published in the Journal of the American Medical Association.
Because women cannot feel if they have dense breasts they have to be told after a scan this new rule from the FDA will help women be better informed about their own health and cancer risk, allowing them to seek consultation earlier and further testing, if necessary. Couric called this an “important step” in a post on Instagram.
Mammogram facilities will have to implement the new rule by September 2024.
Getting Mammograms With Dense Breats
No two breasts are alike not even on the same body! And that’s totally normal. So it’s important and helpful to have a clear understanding about the density of your breasts ask your doctor about it at your next appointment. If you do have dense breasts, they may suggest the need for a 3D mammogram so early signs of anything potentially harmful can be detected more easily.
A major study in Sweden found that 3D mammography detects 34% more cancers compared to traditional mammography.
"With digital mammography, 3D tomosynthesis, we're taking thin slices through the breast tissue, like slices of a loaf of bread," said Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital. "We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread."
It’s important to note that 3D mammograms are not perfect. The new study's researchers found that this method led to more women being called back for additional testing.
And bear in mind that the U.S. Preventive Services Task Force a panel funded by the government whose recommendations are followed by many doctors doesn't recognize the need for 3D mammograms. Consequently, some insurance companies may not pay for it unless you get a letter from your doctor stating that it is medically necessary.
With that, it’s important to consult your doctor or Ob/GYN about your unique situation and the best screening options for you.
It’s also helpful speak up for the care you need. Unfortunately, there's no way to determine if you have dense breasts just by feeling them only a mammogram can determine if you have it. Bestselling author and breast cancer survivor Laura Morton learned a really important lesson about advocating for herself when she was getting a mammogram and questioned her radiologist about dense breasts. The radiologist brushed her off.
READ MORE: When You're Called Back After a Mammogram: Breaking Down the Numbers
"I waited until afterward to mention to her how I felt about her response to what is a really important question, you can not feel if you have dense breasts. You have to be told if you have dense breasts," Laura says. "…So when somebody walks through your door and says, 'Do I have dense breasts?' Answer their question, don't roll your eyes and make them feel small for asking something that we are entitled to know."
Asking doctors questions like, "Do I have dense breasts?" or "Do I need to consider getting a 3D mammogram?" really can save lives. So ask, ask, ask!
When You’re Getting a Mammogram, Ask About Dense Breasts
Other Risk Factors for Breast Cancer
Having dense breasts isn’t the only thing that is associated with a higher risk of breast cancer. In a previous interview with SurvivorNet, Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, laid out several risk factors for breast cancer including:
- Being a woman: Women are at a higher risk for breast cancer, though men can get the disease too.
- Age: "Breast cancer becomes increasingly more common as women age," Dr. Comen said.
- Family history: "Some people think that breast cancer is only inherited through genes on the mom's side,' Comen said. "But it can also be related to genetic mutations that could be found on the father's side."
- Having had a prior biopsy on an abnormal area: "There are different markers, that if a woman has had a biopsy, it's important that she talk to her doctor about whether those markers are lending themselves to an increased risk of breast cancer," Dr. Comen said. If you've had a biopsy that indicated atypical hyperplasia, for example, you are at an increased risk of breast cancer. Atypical hyperplasia isn't cancer, but it is a precancerous condition that describes an accumulation of abnormal cells in the milk ducts and lobules of the breast.
- Radiation exposure: Cancer survivors who've had radiation to their chest are at an increased risk of breast cancer.
Lifetime estrogen exposure: "About 2/3 of breast cancer are driven by the hormone estrogen," Dr. Comen said. "So, that means if a woman has had her period at an early age and started to go through puberty at an early age, at seven, eight, nine, and potentially a later age of menopause, means that her lifetime of having had menstrual periods and being exposed to higher levels of estrogen is higher, and therefore her risk of breast cancer is slightly higher." - Not having a child before age 30 or never having children
- Obesity
- Drinking alcohol
- Lack of exercise: "While there's more research to be done in this area, it looks like if a woman is not exercising, she may also increase her risk for breast cancer," Dr. Comen said.
There’s also the BRCA mutation. The BRCA1 and BRCA2 proteins work as tumor suppressors. They help repair damaged DNA, and are important for ensuring the stability of each cell's genetic material. But when either of these genes is altered, that mutation can mean that its protein product does not function properly, or that damaged DNA may not be repaired correctly. These inherited mutations in BRCA1 and BRCA2 can increase the risk of female breast and ovarian cancers, and have also been associated with increased risks for several other cancers.
Actress Angelina Jolie, now 47, notably revealed 10 years ago that she had the BRCA1 gene mutation and underwent a preventive double mastectomy (removal of both breasts). While that may not be the approach recommended for other people, she chose the procedure to help reduce her risk of developing breast cancer.
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