Understanding Dense Breasts and Its Link to Your Cancer Risk
- British TV presenter Julia Bradbury, 53, is urging others to be aware of the importance of screening for dense breasts, which raises breast cancer risk, and revealed in a recent interview that doctors missed her breast cancer three times before she was diagnosed in 2020.
- Bradbury underwent a double mastectomy and surgery to remove a 6cm tumor in her left breast after learning she had cancer. She’s now in remission.
- The U.S. Preventive Services Task Force recommends women at average breast cancer risk begin screening for breast cancer at age 40. Women with the BRCA gene mutation, who have a family history of cancer or have dense breasts, are at higher risk and should talk with their doctor about when to screen which may be younger than 40.
- Women with dense breasts have more fibroglandular tissue and less fatty breast tissue.
- Breast density is determined through mammograms. However, 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. Food and Drug Administration requires facilities that provide mammograms to tell patients about the density of their breasts. This policy change can directly impact women at higher risk for breast cancer.
The 53-year-old Dublin native, who underwent a double mastectomy and surgery to remove a 6cm tumor in her left breast after learning she had cancer, recently opened up about how doctors missed her breast cancer three times due to her having dense breasts.
Read More“Sign the petition – link in my bio – to help persuade the NHS to start routinely collecting this information to share with woman (which doesn’t currently happen, except in some rare trials across UK). Early detection saves lives,” she concluded. “My breast cancer was missed three times because I have dense breasts.”
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In the video clip, Bradbury is is seen telling her fellow TV presenter how her breast density was “crucial” to getting her diagnosis.
She told Walker, “It’s so good to be here talking about something that genuinely needs to have a wider discussion around it. Dense breasts are basically, it’s nothing to do with the size of your breasts, it’s nothing to do with how they look.
“It is the density of the tissue and you only know if you’ve got dense breasts, if you’ve had breast screenings. So, a mammogram, the radiologist will know.”
When a photo was then shown of Bradbury’s left breast tissue before she had her mastectomy, she explained, “You can see there, that there’s a lot of white tissue. And what that means is it’s very difficult to detect cancer in amongst all of that white. As it was described to me by one doctor, it’s like looking for a snowball in a snowstorm.”
Helping Patients Better Understand Dense Breasts
- When You’re Getting a Mammogram, Ask About 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?
- Millions of Women With Dense Breasts — A New Congressional Law — What You Need to Know
She added, “So this has real implications for women because when they’re having their mammogram screening, it means it isn’t necessarily going to detect many cancers for many women.
“For about 50 percent of women over 40 have dense breasts. [in the U.K.] And dense breasts also equal a higher risk of breast cancer. So it’s incredibly worrying. And there are several things that need to happen.” Bradbury pointed out that in the U.K., women aren’t informed or registered if they have dense breasts.
According to the Susan G. Komen nonprofit organization high breast density is common in the U.S., with 40% to 50% of women between the ages of 40 and 74 have dense breasts.
Dense breasts also varies by age and weight. Susan G. Komen notes that approximately 50% to 60% of women between the ages of 40 and 44 have dense breasts, compared to 20% to 30% of women between the ages of 70-74. Additionally, approximately 50% to 60% of women with a normal/healthy weight have dense breasts, as opposed to 20% to 30% obese women.
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Prior to sharing her interview footage with Channel 5 News, Bradbury also took to Instagram to remind her followers about dense breasts.
She captioned her post, “I have dense breasts which increase your risk of cancer. My cancer was missed x 3 times on mammograms because dense breasts make it difficult to spot tumors. ‘It’s like looking for a snow ball in a snow storm.'”
“We’re not informed in the UK if we have dense breasts and no information is being collated, despite the increased risk. You can ask whether you have dense breasts when you go for a screening but you will not automatically be informed,” she added.
“Head to densebreast-info.org for more information and @breast_density_mattersuk. Sign the petition to help get the NHS on board to share this valuable information. Link in bio.”
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.”
When Should You Consider a Mastectomy?
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.”
Helpful Information About Breast Cancer Screening
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives. For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
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.
WATCH: Understanding the BRCA gene mutation
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 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.
RELATED: 3D Mammography Detects 34% More Breast Cancers Than Traditional Mammography
Family History & Breast Cancer Risk
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Is Genetic Testing Right for You?
Different types of genetic testing can help people with a family history of cancer better ascertain their cancer risks. Your doctor will discuss your family history of cancer with you in the context of your type of tumor and your age at diagnosis. Hereditary genetic testing is usually done with a blood or saliva test.
WATCH: Understanding genetic testing for breast cancer.
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those with a family history to get [genetic testing],” Dr. Ginsburg previously told SurvivorNet. “I would say that if you have anyone in your family diagnosed with a rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome.
The second test involves the genetic sequencing of your tumor if you’ve been diagnosed with cancer by this point. These genetic changes can be inherited, but most arise during a person’s lifetime. This process usually involves examining a biopsy or surgical specimen of your tumor. This testing can lead to decisions on drugs that might work against your cancer.
“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 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.
Screening Options for Women with Dense Breasts
Women with dense breasts should get additional screening to supplement their mammograms. Dense breasts mean more fibro glandular tissue and less fatty breast tissue exists.
The dense tissue has a “masking effect on how well we can perceive cancer and find cancer on mammograms,” Dr. Cindy Ly, a radiology doctor at NYU Langone Medical Center, told SurvivorNet in an earlier interview.
Survivors Encourage Women to Ask Their Doctors About Dense Breasts
Glandular tissue within dense breasts appears white on mammograms, which can help mask potential cancer. The “frosted glass” effect from the glandular tissue can thus mask cancerous areas, especially developing ones. Undetected, these cancers can progress, growing large and advanced. They will then likely require more intensive treatments to cure or can become incurable altogether.
Women with dense breasts may not know they have it based on feeling alone. It’s important to know that breast density is determined by its appearance on a mammogram. Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, previously explained 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.
A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify 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 must be shared with the patient to make the communication clear and understandable.
Questions to Ask Your Doctor
- What is my breast density?
- How has my breast density changed over the years?
- Does my breast density put me at a higher risk for breast cancer?
- Is the rate of change of my breast density concerning for an elevated breast cancer risk?
- How frequently should I get mammograms?
- Which mammogram centers offer 3D mammograms?
- Should I get additional testing, such as breast MRIs, based on my cancer risk?
- What are the benefits and risks of getting additional testing?
Contributing: SurvivorNet Staff
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