Breast density: What does it mean for your annual mammogram?

While we celebrate Breast Cancer Awareness Month every October, breast health and cancer prevention are year-round concerns.

New guidelines from the U.S. Food and Drug Administration have recently stirred conversation about breast density. It is now mandatory for radiologists to inform patients about breast density. It is good that women should have this information and was already required in Delaware.

It did, however, unintentionally cause confusion around possible link between dense breasts 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. On a mammogram, fibroglandular tissue appears whiter, 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 body mass index or 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 an 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 to determine her lifetime risk of breast cancer.

The calculator is free and easily accessible at ibis.ikonopedia.com or by simply googling Tyrer-Cuzick.

Prevention strategies

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 compared to nonsmokers
• It is not recommended to take combination hormone therapy after menopause for more than five 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, call the Beebe Center for Breast Health to make an appointment at 302-703-3595.

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 that can ultimately lower your risk of breast cancer.

For more information, go to beebehealthcare.org/breast-health.