Maggie McKay (Host): Welcome to HealthWorks Here. I'm your host, Maggie McKay. Dr. Dana Xu, Emerson Health general surgeon who specializes in breast health is here to discuss dense breasts with clear answers on what you need to know. Thank you so much for being here today.

Dana Xu, MD: Thanks so much for having me, Maggie.

Host: Many women receiving their mammogram results may learn that they have dense breasts. So, what does dense breasts mean? Should I be worried? How common is it?

Dana Xu, MD: You should not be worried, and it is exceptionally common. There's a couple of different categories for how dense your breast is. There's the category of predominantly fatty. There's a category of scattered fibroglandular densities, which means your generic lumpy breasts. And then, you have the one that everybody gets alarmed about, which is heterogeneously dense breasts, which just means slightly lumpier breasts, and that is about 40% of the entire population, okay? So, about half women out there have some level of lumpy breasts. Lastly, you do have this one rare category of less than 10% of the population where you have exceptionally dense breasts. That can theoretically increase your lifetime risk of breast cancer. But again, that population is much, much rarer.

Host: Is there anything to look for on the report to better understand your breast density?

Dana Xu, MD: What you typically see when you get that report, when you first have your mammogram that says, "Oh no, I have dense breasts," is that term heterogeneously dense breasts. And that is exceptionally common and does not significantly increase your risk for breast cancer. When you have the extremely dense breasts, theoretically, it can almost double your lifetime risk for breast cancer. Why that is, we don't fully know, but. It is one of the risk factors that are out there,

Host: what can women with extremely dense breasts expect?

Dana Xu, MD: So if you do have extremely dense breasts, you would benefit from a higher level of screening. What that screening entails is actually really common sense. The first is a good baseline self-breast exam every month. The second is you still get your lovely smoosh every year with your routine screening mammogram. But what you're adding to that is every year you're also doing an MRI as well. So, what that means is in the span of one year, usually spaced six months apart, you're going to have a mammogram. And then, six months later, you're going to have an MRI.

During that same year, you're also going to be working with both your primary care and ideally, high-risk breast person such as our lovely nurse practitioner, Suzanne Roberts, here, or any number of high-risk breast clinics out there where spaced six months apart from a PCP, you're seeing somebody such as a GYN or your high-risk screener to do a dedicated objective breast exam.

Host: Tell me how I can reduce my anxiety about dense breasts.

Dana Xu, MD: Accept the fact that they're lumpy. Know your lumps, know your bumps. So, I think the biggest and most important thing throughout all of this is, in the entire span of your healthcare, there's one constant. You're going to see lots of different nurses, lots of different doctors. But the one constant is you. You know your breasts. You know how to do that breast exam. Once a month, do your full exam. When you do your exam, you're going from the clavicle, sternum, inframammary fold, all the way up into the armpits. And clockwise, counter-clockwise, I don't care which way you go. Whatever is most comfortable for you, do that.

Feel around and know where those lumps are. This is going to sound a little odd, but I usually call the lumps kind of-- well, I have toddlers at home-- so, I kind of think of them as like the granola clusters that you give them as a snack, because you can feel the little granules on it. If it feels like a little granola cluster in there and you can wiggle it around and it's something that you felt before, you'll be like, "Oh, that's just slumpy. It's just slumpy," that's the slightly more dense breast tissue that's in there. If you feel something that's really hard, firm, increasing in size or tethered where it doesn't have that nice little wiggle, then it's a good time to go touch base your primary care and say, "Hey, take a feel of this. What is it?"

Host: Okay, good to know. If I breastfeed, age, go through menopause or other things that women naturally experience, will my breasts get less dense?

Dana Xu, MD: It does. This is exactly the reason why we don't do routine mammograms on young patients. Because when you are younger, you have a lot more of the stroma that holds everything up and keeps it small, nice and perky early on. But as you age, as the hormone changes, as you breastfeed, a lot of that stroma softens up and has more fatty replacement. So yes, over time, the breasts do soften up

Host: Dr. Xu, when should I see you or another specialist if I'm concerned about something breast-related?

Dana Xu, MD: When something's not right for you. You are doing your routine self-breast exams, you know yourself, you know what's normal for you. When you have something that you go, "Huh, that's different," don't say, "I'll worry about it later." Touch base with your primary care. Have somebody do additional exam. Have your partner, say, "Hey, is this there before?" And if you have that confirmation of like, "This is different," the very first steps that we do is usually imaging. You're going to have that lovely smoosh with the mammogram again. You're going to oftentimes get a targeted ultrasound if they see anything suspicious or if you can point to exactly where that is. And based on that imaging, you come see me and we talk about it.

Host: On a personal note, why do you love being a surgeon who focuses on breast health?

Dana Xu, MD: I just like being a surgeon. Surgery is different than all the other healthcare. Because in all the other specialties, you are constantly being bombarded with all these extra stimuli from following up with this report to seeing your patient within a like a tiny little set period of time. But in surgery, especially when I am doing surgery, I focus on the patient. It's just me and you. Everybody in there is focused on that. No external distractions. I have a problem and I can absolutely fix it, and it's a wonderful feeling.

Host: Well, thank you so much for sharing your expertise. This has been so informative and helpful. Is there anything else you'd like to add in closing?

Dana Xu, MD: No, thank you for doing that. I think every breast is lumpy. Ninety percent of women have some level of lumpy breasts. It's completely normal, and that's in the day. Know your lumps. Know your bumps. Know what's normal for you, and know what's not. And that's it.

Host: Good advice. Thank you so much.

Dana Xu, MD: Thank you.

Host: Again, that's Dr. Dana Xu. Visit emersonhealth.org/breasthealth or call 978-287-3547 to learn more and to make an appointment with Dr. Xu. Thanks for listening to Emerson's HealthWorks Here podcast. Make sure to catch the next episode by subscribing to the HealthWorks Here podcast on Apple Podcasts, Pandora, Spotify, or wherever podcasts can be heard.