Mammography - Dense Breast Tissue Concerns
Every woman must decide when or if they will have a diagnostic mammogram. According to the National Cancer Institute, more than 260,000 women were diagnosed with breast cancer in 2018, and more than 40,920 died of this disease. There have been advances in breast cancer detection with the increased use of 3-D digital screening, along with more uniform breast density reporting.
A mammogram is considered the first step in detecting breast cancers and treating them early. Making a decision on having a mammogram before the age of 50 is an individual one. Many women have a biennial screening between the ages of 40 to 49 and biennial mammograms for women of normal risk is encouraged between the ages of 50 to 74. The USPSTF (U.S. Preventative Services) concluded that there is no evidence of benefit or harm in testing women over the age of 75 years. In addition, breast cancer does occur in men, typically between the ages of 60 to 70 years of age.
Women between the ages of 60 to 69 are in the most important age range to have mammograms and to avoid death from breast cancer. Women with a sibling, parent or child with breast cancer should start their screenings in their 40s. While the mammogram may reduce death from breast cancer for women from 40 to 49 years the number of false-positives also increase, so further screening and biopsies increase and may cause harm.
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Dense Breast Tissue
Approximately 40% of women have dense breast tissue and 10% of those have extremely dense tissue, which makes cancer cells more difficult to detect. The dense breast tissue actually masks small growths. This breast tissue is a risk factor for developing cancer. Earlier this year a U.S. law was passed that requires mammogram reports to include an assessment of the density of a woman’s breast tissue, and it must also include an explanation if the mammogram results are difficult to interrupt.
There is a recent study published in the New England Journal of Medicine that provides data to suggest that women with dense breast tissue should have an MRI. However, there is some concern about women having an MRI as some of the “cancers” identified are actually in a precancerous stage. This is a growth called ductal carcinoma in situ, which means it may not grow or progress into a disease. If the MRI reveals these growths it may lead to overdiagnosis, thus over-treatment. Biopsies may be ordered.
Another large study in Denmark found that one quarter to one third of the breast tumors diagnosed in women who had an MRI were over-diagnosed and many of the irregularities found were not the type of tumors that causes a health problem, let alone death. The U.S. Preventive Services Task Force has concluded there is not enough evidence to advise women about the harm or the benefits of testing beyond a mammogram.
The American Cancer Society lists risk factors of breast cancer, as follows:
- Being born female
- Getting older, especially over 55 years of age
- Inheriting a gene from a parent that causes breast cancer, which accounts for 5% to 10% of breast cancers
- Inheriting the mutated BRCA1 or BRCA2 genes, as it increases the risk to 7 in 10 for getting breast cancer and at a younger age also
- Women who have 2 to 3 or more alcoholic drinks daily are at a 20% higher risk
- Being obese after menopause if they gained the weight as an adult is a risk
- Sedentary lifestyle after menopause (recommended 150 minutes of moderate exercise)
- Never having children or having a first child after 30 years old slightly increases risk
- Some birth control methods slightly increase the risk
- Breast implants slightly increase the risk
Other gene mutations that aren’t as serious as the BRCA mutation include: ATM gene ataxia-telangiectasia), TP53 (rare and it causes other cancers also), CHEK2, PTEN CDH1, STK11 and PALB2. When these genes are healthy they help repair DNA or they help with cell growth.
Women who have a father or brother with breast cancer are at a significantly higher risk. Taller women are also at a slightly higher risk, which is not understood. Women with dense breast tissue are at a 1.5 to 2 times greater risk than women with average breast density. Women who do not go through menopause until after age 55 are a slightly higher risk.
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New Breast Cancer Treatment
There is a recent groundbreaking study using radiation treatment for breast cancer that is completed in just 10 days. It was found to be just as effective as the treatment that lasts for 6 weeks. This study included 520 women with stage 1 and stage 2 breast cancer. The patients received radiation treatment 5 times over 10 days. The initial treatment removed the tumor, then the women received the 10 day treatment. There was no difference in the survival rate or for tumor recurrence as compared to patients who had whole breast radiation.
Women must decide when they want a mammogram. Of course, if they find a lump in their breast at any age it should be reported to their physician. Women should do a monthly check for lumps to be on the safe side.
If they are at a higher risk based on the risk factors listed listed above, then they should consider getting a mammogram. They could also get a blood test to check for the BRCA genes if there is breast cancer in their family, as knowing if they are at a higher risk could save their lives.
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This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 Pamela Oglesby