Do you know how dense your breasts are? If you’re a woman age 40 or older, you should.
Breast density — or the amount of fibrous breast tissue compared to the amount of fatty tissue — is an important factor to consider when making decisions about when to start screening for breast cancer and how often to schedule those regular mammograms.
(Hint: SMH recommends yearly mammograms for all women, starting at age 40.)
What Is Breast Density & Why Does It Matter?
Not only do women with dense breasts have an increased risk of breast cancer, but dense breasts can also make it more difficult for mammograms to pinpoint early-stage cancerous tumors.
“In a mammogram, fatty tissue appears gray or black on the X-ray,” says Steven Merandi, MD, a breast imaging specialist at Sarasota Memorial’s Breast Health Center. “Dense tissue appears white, as do many cancers, so it actually blends in and can obscure early signs of breast cancer.”
Unrelated to breast size or firmness, breast density is assessed via mammogram and classified on a scale of A to D, from almost entirely fatty (A) to extremely dense (D). And although it is loosely associated with age — nearly 75 percent of women in their 30s have dense breast tissue — more than 25 percent of women in their 70s also have dense breast tissue, meaning their breasts have more glandular and connective tissue than fatty tissue.
Roughly half of all American women would qualify as having dense breasts.
What Does This Mean for My Mammogram?
“Mammography is still the gold standard for detecting breast cancers,” Merandi says, “and we know it saves lives.”
And with the adoption of 3D mammography as the standard of care regardless of breast density, the risk of missing early-stage cancers is even lower.
The imaging machine moves around the breast in an arc, taking multiple X-rays that a computer forms into a 3-dimensional image. This allows radiologists to assess several layers of the breast at a time and to navigate around tissue that might hide a cancer.
“But no tool is perfect,” Merandi continues, “especially for women who have dense breasts.”
For that reason, Sarasota Memorial radiologists document breast density in every mammography report and encourage a woman’s referring physician to discuss additional screenings if indicated — such as ultrasound and breast MRI, which can detect tumors that mammograms can’t see.
Read more on those below.
Scheduling a Mammogram
Women age 40 or older should have a screening mammogram each year. Once you’ve talked to your doctor about the best breast imaging for you, your doctor will order the screening.
If you don’t have a primary care doctor or gynecologist, reach out to Sarasota Memorial’s HealthLine physician referral team for assistance (941-917-7777); call the Breast Health Center at 941-917-7322; or visit smh.com/breasthealth for more information. Self-referral is also now an option for an initial screening mammogram.
Women who are uninsured or cannot afford a mammogram, breast biopsy or other breast health service should call our Breast Health Grant Support Program for assistance: 941-917-7642.
Supplemental Cancer Screening for Dense Breasts
Women with dense breasts may benefit from the following imaging technologies as supplements or alternatives to screening mammograms:
Breast Ultrasound — For patients with dense breasts who are at lower risk for developing breast cancer, ultrasound is often the preferred follow-up to a mammogram. Ultrasound uses high-frequency sound waves and a computer to create images that help diagnose breast abnormalities, such as a benign fluid-filled cyst or a solid lump. It can be used to supplement mammography for a woman with dense breasts, but it’s not typically used as a screening tool or in place of mammography, as calcifications (which can be an early sign of cancer) cannot be well visualized using ultrasound. It also can give false positive readings; so again, it’s important to discuss this option with your doctor.
Breast MRI — Often recommended for women who have had breast cancer before, a family history of breast cancer or those who would benefit from a higher sensitivity, lower radiation screening, magnetic resonance imaging (MRI) may reveal additional breast cancers obscured on both mammography and ultrasound screening. MRI uses a combination of a large magnet, radiofrequencies and a computer to produce detailed images of breast tissue. MRI does not use radiation, but usually requires the use of a contrast dye to help create clearer images and outline abnormalities. It can also help detect breast cancer in women with breast implants and in younger women with dense breast tissue.
Get Screened: When & Where
When: Breast oncology experts at Sarasota Memorial’s Brian D. Jellison Cancer Institute advise all women to have a breast cancer screening annually starting at age 40, in addition to an annual clinical breast exam. Women should talk to their primary care physicians or gynecologist about the various screening mammography options to decide which one is the best fit, given their individual risk level, health history, breast density and other factors.
Where: To ensure reliable imaging and results, women should choose a mammography center that is an American College of Radiology “Gold Standard” Breast Imaging Center of Excellence and that offers digital mammography. Women with dense breasts or other risk factors may need 3-D digital mammography or other advanced diagnostic capabilities such as ultrasound and breast MRI.
Named a Breast Imaging Center of Excellence by ACR, Sarasota Memorial offers digital mammography, 3D mammograms and other advanced breast imaging options at 8 locations across Sarasota County. For information on screening locations and services, call Sarasota Memorial’s Breast Health Center at 941-917-4103 or click here.