Breast Density is in the News: What Does it Mean for Your Annual Mammogram?

While we celebrate Breast Cancer Awareness month every October, breast health and cancer prevention is a year-round task. Recently, new guidelines from the FDA have stirred conversation about breast density. It is now mandatory for radiologist to inform patients about breast density. Women should have this information, and disclosure was already required in Delaware. It did, however, unintentionally cause confusion around the link between dense breast and cancer risk. Dense breasts always make the mammogram more difficult to read, but they do not always indicate increased risk of breast cancer.

Breast mammographic density is a function of how much fat is in the breast relative to the rest of the structures in the breasts: the blood vessels, milk ducts, milk lobules and connective tissue, collectively known as fibroglandular tissue. Fibroglandular tissue appears whiter on a mammogram, whereas fat appears darker. Breast density can’t be a sole factor to determine if you’re at increased risk or if you need additional imaging. For instance, a 40-year-old athlete will have a very dense breast on mammogram, but her risk of developing breast cancer is likely very low. Dense breast is normal in a premenopausal woman who is not overweight.

When Extra Imaging is Useful

However, dense breasts are not expected in a post-menopausal woman, especially if she has a higher BMI. Her mammogram should have either “scattered fibroglandular density,” or “almost entirely fatty” density level. In this woman, dense breast does indicate increased risk of breast cancer as well as difficulty interpreting the mammogram. This woman should have either annual MRI as well as mammography or contrast enhanced mammography annually.

Know Your Personal Risk

The American Cancer Society and other national organizations encourage every woman 25 or older to use a validated breast cancer risk calculator such as Tyrer-Cuzick and determine her lifetime risk of breast cancer. The calculator is free and easily accessible.

Regardless of whether your Tyrer-Cuzick lifetime risk of breast cancer is average or high, each of us should be mindful to these strategies for lowering one’s risk. Some general guidelines to remember:

• 150 minutes a week of moderate physical activity reduces risk by 20-50%
• The rate of new breast cancer cases is 24% higher among smokers than among nonsmokers
• It is not recommended to take combination hormone therapy after menopause for more than 5 years
• Having a BMI of 30 or higher after age 18 increases the risk of breast cancer as much as 30%.

Know When to Act

If you find that you have a lifetime risk of breast cancer that is 20% or greater, please call the Beebe Center for Breast Health to make an appointment. We will help you find the most appropriate path forward, including whether you should consider genetic testing and whether you should have additional breast imaging. Most importantly, we can help you identify lifestyle adjustments, which can ultimately lower your risk of breast cancer.

To contact the Center for Breast Health, call 302-703-3595, or visit the Breast Health service page for more information.

Diana Dickson-Witmer, MD, is a board-certified surgeon who leads Beebe’s Center for Breast Health with decades of experience and expertise in the field of breast surgery and oncology. In addition to her surgical and patient care experience, Dr. Dickson-Witmer is known for her trailblazing work in the field of breast surgery – setting the standard and developing the programs to train future surgeons in the field. She has been featured in numerous medical publications, given hundreds of presentations, and served on three medical missions, one in Africa and two in Central America.