October is Breast Cancer Awareness Month and it also just so happens to be the month that I take care of those yearly wellness visits. Eye Exam. Physical. GYN visit. Before seeing my GYN doc, the nurse was reviewing my history…and asked about my mammogram and if there was every anything unusual in my breasts. I replied, “No, just that they are dense.” She responded, “Yes, just like everyone else.” It was what I call a ‘throw away’ comment. And it got me thinking what does it mean that I have dense breasts? And then I started thinking that if I had questions maybe some of you would too.
Some of you know what happens when I start thinking…I go to the literature. First, I went back and reminded myself what are breast tissues made up of.
- Globules or the tissue that produces milk
- Ducts which carry the milk to the nipple
- Fatty tissue which is similar to the fat tissues in the body and also known as non-dense tissue
- Fibrous connective tissue that holds the breasts together and gives them shape and also known as dense tissue
Dense breast tissues have more globules, ducts and fibrous connective tissue and less fatty tissue. In the medical world breasts like this are also called more “active” and one theory why women with more dense breasts have a higher incidence of breast cancer is that there is more tissue where most cancers start. AND having dense breasts makes it more difficult for the radiologist to see any tumors because density shows up as dense white not as transparent as the fatty tissue.
When should you have a mammogram? Again, there are no cut and dried standards. Here is a link to the Center for Disease Control that lists 7 different organizations including the American Cancer Society, The American College of Obstetrics and Gynecology and the U.S. Preventive Task Force: https://www.cdc.gov/cancer/breast/pdf/breastcancerscreeningguidelines.pdf. Generally speaking, women should have a screening mammogram in their early 40s. Thereafter depending on which organization, it should be every 1-2 years until you reach your mid-seventies.
The only way to determine if you have dense breasts is to have a mammogram because dense breasts don’t look or feel any different than non-dense breasts. A radiologist reads the mammogram and uses a 1-4 scale to grade the density. Women who score a 3 or 4 are considered to have high density breasts.
Mammogram facilities in Virginia, Maryland and the District are already required to send out letters informing women about their breast density. But what do you do with this information? There are no standards of plans to manage this information and many times women are left more confused or not understanding the risks (because of that throw away comment like I received).
Density can change over time. Younger women tend to have more dense breasts, but not always. Women with less body fat are more likely to have denser breast tissue than women who are obese. And women who take combination hormone therapy leading up to and during menopause are more likely to have dense breasts. The best thing is to talk to your doctor and help figure out how often you should have a screening mammogram and if there is other imaging that may be better for you.
While many risk factors for breast cancer—such as the age you got your first menstrual period, family history, your genetic makeup and breast density—are not things you can change, there are several risk factors that you can modify, fairly easily, including:
- Not drinking alcohol. Even as little as one drink a day can increase your risk of breast cancer. A 2002 analysis of 53 studies published in the British Journal of Cancer found that for every daily drink, the relative risk of breast cancer rose by about 7%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562507/
- Becoming more physically active. Evidence is growing that regular physical activity reduces breast cancer risk, especially in women past menopause. The main question is how much activity is needed. Some studies have found that even as little as a couple of hours a week might be helpful, although more seems to be better.
- Not smoking. There is a stronger link when women are premenopausal.
- Maintaining a healthy weight.
- Eating a healthy, whole foods, mostly plant diet such at the Mediterranean diet has been shown to reduce the risk of breast cancer as much as 15%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303126/
I am fortunate in that there is no family history of breast cancer in my family and although I have had “dense breasts” since I started being screened, I have done pretty well in mitigating my risks by following the above as well as breast feeding both of my boys, and limiting my use of hormonal birth control. And even though the latest research shows breast self-exams are beneficial, I still do them. I believe that every women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away.
So there you have it, my latest on Wonder Wednesday. Let me know what you are wondering about so we can all learn together.