When we look at a mammogram, one of the first things we look at is breast density – the amount of fibroglandular tissue in the breast compared to the amount of fat. The higher proportion of breast tissue to fat, the denser the breast.
Why does breast density matter?
On a mammogram, fat looks dark grey or black whereas breast tissue looks white. That white area can be an issue because many small breast cancers also appear as white, so it’s harder to detect them in dense breasts.
In this important segment, Marie Quinn, MD, Assistant Professor of Oncology in the Department of Diagnostic Radiology at Roswell Park Comprehensive Cancer Center, discusses why women should know if they have dense breasts and how breast density can affect cancer risk.
What Does It Mean to Have Dense Breasts
Featured Speaker:
Learn more about Marie Quinn, MD
Marie Quinn, MD
Marie Quinn, MD, Assistant Professor of Oncology in the Department of Diagnostic Radiology at Roswell Park Comprehensive Cancer Center.Learn more about Marie Quinn, MD
Transcription:
What Does It Mean to Have Dense Breasts
Bill Klaproth (Host): So, what are dense breasts? Why does breast density matter? How does dense breast tissue affect breast cancer risk? Here to discuss what it means to have dense breasts is Dr. Marie Quinn, assistant professor of oncology, department of diagnostic radiology at Roswell Park Comprehensive Cancer Center. Dr. Quinn, thank you for your time today. So, let’s start here. What are dense breasts?
Dr. Marie Quinn, MD (Guest): Hi Bill, thank you so much. Yes, so dense breasts – what we do when we look at the mammogram is one of the first things we evaluate is how much fibroglandular breast tissue there is compared to the amount of fat in the breast and those are both normal structures. Younger women tend to have more of the fibroglandular tissue which actually looks white on the mammogram, relative to the fat which looks dark gray or black on the mammogram. The reason that we look at that is because breast cancers also look white on the mammogram, so it is harder to find small cancers in women that have a lot of dense tissue as opposed to women that have mostly fatty tissue.
Bill: So, is there a way for a woman to know whether or not she has dense breasts without having a mammogram first?
Dr. Quinn: Actually there isn’t. Really the only way to tell is to have a mammogram because just the way the breasts look or feel you can’t tell how dense the actual tissue is.
Bill: Okay and so, does that change the screenings or types of mammograms you recommend?
Dr. Quinn: What we have at Roswell Park, is we have the 3D mammogram or the tomosynthesis and we do recommend that in women with dense tissue and also in women that don’t have dense breast tissue. So, the recommendations that we follow are the National Comprehensive Cancer Network or NCCN guidelines and that is for yearly screening mammography beginning at age 40. So, all women regardless of their breast density should be having a yearly mammogram beginning at age 40. Now women who have been identified on their mammogram to have dense tissue; the 3D mammogram is helpful because it does pick up more cancers than the 2D mammogram alone. The 3D mammogram is also called tomosynthesis. In addition to mammography, some women that have dense breasts will also have a screening breast ultrasound and that can be done either by a doctor or a technologist who has the ultrasound probe and looks at all areas of the breast themselves. Some places also have an automated breast ultrasound and what the ultrasound does is it doesn’t replace the mammogram. The women still need the yearly mammogram which is really the only way we can see calcifications which can be the sign of early breast cancers, so it is important to know that ultrasound wouldn’t replace a mammogram in women with dense tissue. But it can also – it has also been shown to pick up more cancer in women with dense tissue. The slight drawback to screening ultrasound is that it also has a higher false positive rate meaning we tend to find more little areas in the breast that might turn out to be nothing but may lead to a biopsy that is benign or to follow up that doesn’t turn out to be breast cancer.
Bill: And Dr. Quinn, does a woman with dense breasts need to be screened more often?
Dr. Quinn: No. the recommendation is still for yearly screening mammograms.
Bill: So, for a woman with dense breasts, how does that affect the breast cancer risk?
Dr. Quinn: So, there is a slightly increased risk for developing breast cancer in women with dense breast tissue. This is thought to be attributed just probably to the fact that there is more glandular tissue relative to the fat and that is the tissue that can – is active and can turn into breast cancer. So, there is a slight increased risk, but not enough that the patient would need additional screening with MRI or more frequent mammograms than once a year.
Bill: So, are certain women more likely to have dense breasts?
Dr. Quinn: So, actually dense breast tissue is more common in younger women, so over half of women under age 50 will have dense tissue. As we get older, we tend – our breast density tends to become less dense and that’s mostly because the tissue responds to hormones, so after women go through menopause; we tend to see that their breast tissue becomes less dense. So, many women will be categorized as having dense tissue, but then as they get older will move into the non-dense category. Women who are on hormone replacement or HRT can also have denser breast tissue and we see that if they stop the hormone replacement, that again, the breast tissue, the density will go down. A lot of it though, I mean you can’t always predict who is going to have dense tissue. Some of it is genetic and just how we are made. Really the only way to know is to have a mammogram and to know your own breast density.
Bill: Yeah, I was just going to ask you is having dense breasts hereditary?
Dr. Quinn: Probably that is a component as well and but again, there is no way to know without having the mammogram and women that have dense tissue really, it is mostly just important to know that you have dense tissue to know that your mammogram is harder to read because of that and to be proactive and make sure you are best testing with the 3D mammogram and considering doing the breast ultrasound.
Bill: You know it is kind of interesting. So, you really don’t know until you go for that first screening and the guidelines right now are 40 years of age, so most women probably have no idea until they hit that first screening at 40 then.
Dr. Quinn: Right and it’s very common again for younger women to have dense tissue, so I would start the screening at age 40, the 3D mammogram as I have been saying has been a great newer tool that really helps us pick up more smaller breast cancers earlier. I do want to emphasize though for women that most mammograms are normal. We do call back around 10% of women who have their first mammogram. It’s slightly higher for the very first mammogram. We will need additional pictures for the mammogram, might need ultrasounds, but the vast majority of mammograms are normal. So, if a woman is 40 and she hasn’t had her mammogram yet, we encourage them to come in and get it checked out just for the peace of mind.
Bill: And can you talk about the difference between the 3D screening and traditional screening?
Dr. Quinn: Sure. So, the mammogram unit, the machine that takes the pictures actually looks very, very similar and we still use compression, less compression than we have had to use in the past. The breast is still placed in a light compression and instead of taking the picture straight on; it actually takes multiple pictures along an arc and when we look at the images, what we can see is – it’s almost like slicing through a loaf of bread. We can page through the mammogram and look at the tissue that is overlapping. It’s very helpful because sometimes especially women who have dense tissue, the tissue can overlap, and it can make different patterns that can sometimes look like a mass which is why we would in the past, have to do a lot of additional pictures to show that there is nothing there. With the 3D mammogram, it’s very helpful because we can scroll through the pictures right after they are done and often see that it’s just overlapping tissue. And one of the real main benefits of 3D mammography in the screening setting is that it’s lowered the rate of callbacks, so it has lowered the rate of having to have additional pictures done with the mammogram. So, that’s great for the patients that it hopefully lessens some of their anxiety and needing to have additional pictures.
Bill: And how about the time it takes to get the results? Is it quicker with 3D imaging or about the same?
Dr. Quinn: It does take a little bit longer for the radiologist to read the 3D mammogram because there is more pictures to look at instead of looking at four standard pictures, we get maybe about 90 per view that we scroll though, so it takes a little bit longer for us to read it. We do offer for the patients that come to Roswell to have their mammogram read the same day, if they would like, so that they know or they can also come in for an express appointment, meaning they will have their mammogram done within about 30 minutes and then we will call them with the results.
Bill: Alright, well Dr. Quinn, thank you so much for your time today. We appreciate it. For more information you can visit www.roswellpark.org that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
What Does It Mean to Have Dense Breasts
Bill Klaproth (Host): So, what are dense breasts? Why does breast density matter? How does dense breast tissue affect breast cancer risk? Here to discuss what it means to have dense breasts is Dr. Marie Quinn, assistant professor of oncology, department of diagnostic radiology at Roswell Park Comprehensive Cancer Center. Dr. Quinn, thank you for your time today. So, let’s start here. What are dense breasts?
Dr. Marie Quinn, MD (Guest): Hi Bill, thank you so much. Yes, so dense breasts – what we do when we look at the mammogram is one of the first things we evaluate is how much fibroglandular breast tissue there is compared to the amount of fat in the breast and those are both normal structures. Younger women tend to have more of the fibroglandular tissue which actually looks white on the mammogram, relative to the fat which looks dark gray or black on the mammogram. The reason that we look at that is because breast cancers also look white on the mammogram, so it is harder to find small cancers in women that have a lot of dense tissue as opposed to women that have mostly fatty tissue.
Bill: So, is there a way for a woman to know whether or not she has dense breasts without having a mammogram first?
Dr. Quinn: Actually there isn’t. Really the only way to tell is to have a mammogram because just the way the breasts look or feel you can’t tell how dense the actual tissue is.
Bill: Okay and so, does that change the screenings or types of mammograms you recommend?
Dr. Quinn: What we have at Roswell Park, is we have the 3D mammogram or the tomosynthesis and we do recommend that in women with dense tissue and also in women that don’t have dense breast tissue. So, the recommendations that we follow are the National Comprehensive Cancer Network or NCCN guidelines and that is for yearly screening mammography beginning at age 40. So, all women regardless of their breast density should be having a yearly mammogram beginning at age 40. Now women who have been identified on their mammogram to have dense tissue; the 3D mammogram is helpful because it does pick up more cancers than the 2D mammogram alone. The 3D mammogram is also called tomosynthesis. In addition to mammography, some women that have dense breasts will also have a screening breast ultrasound and that can be done either by a doctor or a technologist who has the ultrasound probe and looks at all areas of the breast themselves. Some places also have an automated breast ultrasound and what the ultrasound does is it doesn’t replace the mammogram. The women still need the yearly mammogram which is really the only way we can see calcifications which can be the sign of early breast cancers, so it is important to know that ultrasound wouldn’t replace a mammogram in women with dense tissue. But it can also – it has also been shown to pick up more cancer in women with dense tissue. The slight drawback to screening ultrasound is that it also has a higher false positive rate meaning we tend to find more little areas in the breast that might turn out to be nothing but may lead to a biopsy that is benign or to follow up that doesn’t turn out to be breast cancer.
Bill: And Dr. Quinn, does a woman with dense breasts need to be screened more often?
Dr. Quinn: No. the recommendation is still for yearly screening mammograms.
Bill: So, for a woman with dense breasts, how does that affect the breast cancer risk?
Dr. Quinn: So, there is a slightly increased risk for developing breast cancer in women with dense breast tissue. This is thought to be attributed just probably to the fact that there is more glandular tissue relative to the fat and that is the tissue that can – is active and can turn into breast cancer. So, there is a slight increased risk, but not enough that the patient would need additional screening with MRI or more frequent mammograms than once a year.
Bill: So, are certain women more likely to have dense breasts?
Dr. Quinn: So, actually dense breast tissue is more common in younger women, so over half of women under age 50 will have dense tissue. As we get older, we tend – our breast density tends to become less dense and that’s mostly because the tissue responds to hormones, so after women go through menopause; we tend to see that their breast tissue becomes less dense. So, many women will be categorized as having dense tissue, but then as they get older will move into the non-dense category. Women who are on hormone replacement or HRT can also have denser breast tissue and we see that if they stop the hormone replacement, that again, the breast tissue, the density will go down. A lot of it though, I mean you can’t always predict who is going to have dense tissue. Some of it is genetic and just how we are made. Really the only way to know is to have a mammogram and to know your own breast density.
Bill: Yeah, I was just going to ask you is having dense breasts hereditary?
Dr. Quinn: Probably that is a component as well and but again, there is no way to know without having the mammogram and women that have dense tissue really, it is mostly just important to know that you have dense tissue to know that your mammogram is harder to read because of that and to be proactive and make sure you are best testing with the 3D mammogram and considering doing the breast ultrasound.
Bill: You know it is kind of interesting. So, you really don’t know until you go for that first screening and the guidelines right now are 40 years of age, so most women probably have no idea until they hit that first screening at 40 then.
Dr. Quinn: Right and it’s very common again for younger women to have dense tissue, so I would start the screening at age 40, the 3D mammogram as I have been saying has been a great newer tool that really helps us pick up more smaller breast cancers earlier. I do want to emphasize though for women that most mammograms are normal. We do call back around 10% of women who have their first mammogram. It’s slightly higher for the very first mammogram. We will need additional pictures for the mammogram, might need ultrasounds, but the vast majority of mammograms are normal. So, if a woman is 40 and she hasn’t had her mammogram yet, we encourage them to come in and get it checked out just for the peace of mind.
Bill: And can you talk about the difference between the 3D screening and traditional screening?
Dr. Quinn: Sure. So, the mammogram unit, the machine that takes the pictures actually looks very, very similar and we still use compression, less compression than we have had to use in the past. The breast is still placed in a light compression and instead of taking the picture straight on; it actually takes multiple pictures along an arc and when we look at the images, what we can see is – it’s almost like slicing through a loaf of bread. We can page through the mammogram and look at the tissue that is overlapping. It’s very helpful because sometimes especially women who have dense tissue, the tissue can overlap, and it can make different patterns that can sometimes look like a mass which is why we would in the past, have to do a lot of additional pictures to show that there is nothing there. With the 3D mammogram, it’s very helpful because we can scroll through the pictures right after they are done and often see that it’s just overlapping tissue. And one of the real main benefits of 3D mammography in the screening setting is that it’s lowered the rate of callbacks, so it has lowered the rate of having to have additional pictures done with the mammogram. So, that’s great for the patients that it hopefully lessens some of their anxiety and needing to have additional pictures.
Bill: And how about the time it takes to get the results? Is it quicker with 3D imaging or about the same?
Dr. Quinn: It does take a little bit longer for the radiologist to read the 3D mammogram because there is more pictures to look at instead of looking at four standard pictures, we get maybe about 90 per view that we scroll though, so it takes a little bit longer for us to read it. We do offer for the patients that come to Roswell to have their mammogram read the same day, if they would like, so that they know or they can also come in for an express appointment, meaning they will have their mammogram done within about 30 minutes and then we will call them with the results.
Bill: Alright, well Dr. Quinn, thank you so much for your time today. We appreciate it. For more information you can visit www.roswellpark.org that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.