Dense breast tissue? Issues and comparative techniques

I’ve recently become involved - thanks to another cancer survivor friend back in New York state - with the Are You Dense campaign to inform women of the risks involved with relying too heavily on mammography alone if they have dense breast tissue as defined by the BIRADS Scale - a way that radiologists can classify the images seen on a mammogram.

Here’s is a basic bit on the physic and limitations of mammograms that you should be aware of, particularly if you pre or peri menopausal:

Basic Physics of Mammography:

X-ray images depend on differences in x-ray stopping power (attenuation) to separate tissues. In general, a clear separation between normal functioning tissue, and abnormal cancerous tissues is not possible since their attenuation if very similar. However both functional tissue and cancer can be separated from fatty storage tissues which normally surround active breast tissue, even in lean persons. This is due to a substantially lower attenuation caused by fat.

In older women, the functional glandular tissue diminishes, leaving only thin supporting tissues clearly outlined by fatty tissues. Mammography in these “mature” breasts is very effective, since even small cancers are well outlined by fat. In addition, many cancers develop calcium deposits which strongly stop X-rays and are easily seen on mammograms.

Basic Limitations of Mammography:

Since mammography cannot separate normal gland tissue from tumors, it is much more effective when gland tissue diminishes with age. Many women retain glandular tissue as they “mature”, and it camouflages tumors until they are large. As you might expect, the young women’s breast normally contains more active tissue, which again interferes with detection of small cancers.

Breast Composition Determination:

The ACR-BIRAD system recognizes this limitation by reporting the background composition of the breast in categories:

1.) Almost Entirely Fatty: Mammography very effective, sensitive to even small tumors.

2.) Scattered Fibroglandular tissue: Minor decrease in sensitivity.

3.) Heterogeneously Dense tissue present: moderate decrease in sensitivity.

4.) Extremely dense tissue present: marked decrease in sensitivity.

Mammography does retain some value even in dense breasts, by detecting calcium deposits (which are so dense, surrounding tissue does not interfere), but is not reliable in detecting small non-calcified cancers. In general, women with “dense” breasts remain so from year to year, and it is possible to let a women know when she cannot depend on mammography. In dense breasts, more emphasis on self-examination may be appropriate, particularly if there is a family history of breast cancer.

My breast cancer -  as determined by mammogram alone here in Reno - was supposedly ‘early stage’. Unfortunately, that wasn’t really the case. Had I allowed treatment, using this inaccurate staging, my chances of survival would have been very slim at best. Even pursuing a biopsy here would have set me on a course of disasterous results. Canceling my surgery without so much as discussion of a biopsy - that had been hastily scheduled by a local surgeon - I went OUT OF THE AREA to get a second opinion. By out of area, I don’t mean to the next town. That’s not out of area. I went to the University of Texas, MD Anderson Cancer Center in Houston, Texas which is a multi-disciplinary cancer center. There are many multi-disciplinary, comprehensive cancer centers located around the country and you probably have one near you.

I chose MD Anderson because, A- they were consistently ranked as either the number 1 or 2 leading cancer center in the entire country, B- what they told me was so educational/informational/rational and made such good sense in a way I could understand, that there was no question of going elsewhere. They made a strong, comprehensive case and backed it up, unlike the docs in Reno who seemed to be playing it by ear.

Bottom line: My cancer WAS NOT EARLY STAGE. It was late stage and large, requiring an entirely different treatment protocol. This was because I had extremely dense, fibrocystic breast tissue which had obscured the tumor. I knew about this from an ultrasound years before, but nobody ever explained how this mattered to me - how it would decrease my chances of getting an accurate mammogram, and find a cancer early when it was most treatable.

There are different types of breast imaging modalities now available. They each have their pluses and minuses. But when used appropriately - in concert with each other - they provide powerful tools to accurately depict and diagnose breast cancer at its earliest stage.

You can click on this image for more information

Here is a great comparative discussion of the different breast imaging modalities. The include breast ultrasound, Molecular Breast Imaging, Breast MRI, PEM and others.

To this end, however, it’s imperative that more women understand their own breast tissue density and what that implies regarding the ability of diagnostic radiologists in their area to get the best, most precise picture of their breast tissue and any abnormalities. Connecticutt has actually passed a law that women must be informed of this. Every state should have this mandate on their books, despite what the TeaParty and Libertarians think about mandates. In this case, at least, they save lives.

One caveat is important to remember. Ultrasound - which is an extremely accurate and useful way of viewing breast tissue - is highly dependant on the skill, experience and overall expertise of the technician/operator. At present, there is a shortage across the United States of ultrasound techs that can truly utilize this modality to its best. This is another reason to get the hell out of your local area and go to a cancer center - somewhere that does nothing but breast imaging - by the thousands.

These centers attract the best of the best in technical expertise - like MD Anderson and other comprehensive cancer centers. There is simply no substitute for this, since that initial diagnosis and staging is so critical to the ultimate outcome of breast cancer treatment and whether the cancer recurs.

At MD Anderson, the doctor that did all the ultrasounds on my breasts has been a leader in the field for many years. He was able to actually assess the involvement of the lymph nodes prior to any surgery or biopsy. Later, when a suspicious lesion was found, he was able to guide a Fine Needle Aspiration biopsy - with the Pathologist and her microscope right in the ultrasound room to read it immediately - by ultrasound. It was determined right then and there that it was a benign lesion. This put my anxieties to rest immediately - no waiting around for a report a week later.

Every woman should have some clue as to what the different ‘architectures’, tissues, masses and such look like and what the meanings are - this keeps you from being unnecessarily frightened by a report. Remember, knowledge is power. It can also help you sleep nights.

Read through the information on this Creighton University mammography website. Bookmark it. Refer to it before you get your mammogram, and even print it out and take it with you so that you can rationally discuss any initital findings right there with the radiologist.

For more information on breast tissue density, click on the following:

So, please … get the facts. Read all you can. Don’t become a victim of the local ‘we’ve always done it this way’ mentality. You get one first chance to beat breast cancer - any cancer - and you MUST get it right the first time.

You may not live to be a ‘wish I had only …’

-maven

Breast density petition to Congress. Please sign today!

The following message was sent to me from a breast cancer buddy back in New York state - Teresa.

Read on:

Most of you know my sad story. A cancerous lump grew year after year completely undetected by mammography because of my breast density. I  finally felt the lump myself but at that point the tumor was already invasive and had spread to my lymph node system. I was shocked to learn 95%  of women do not know (and I didn’t) their own breast density;  your doctor is not obligated to tell you.

Women with dense breasts are more likely to get breast cancer, it is more likely to be aggressive and a mammography will   find LESS THAN HALF of these cancers in women with the densest breasts.Connecticut is the ONLY state with a law on the books mandating that a woman be told about her breast density and offered additional screening tools like an ultrasound or MRI.

This is an online national petition to make Connecticut’s Breast  DensityInform Law - a federal law.

Please click here to sign and send a petition to your Senators and House Representatives along with President Obama. We are a grass roots movement of women, all of whom have been diagnosed with cancer at a later stage than necessary because mammograms could not detect cancer in our dense breasts.

If “early detection saves lives” is still the golden rule, it is vital information currently denied women with dense breasts. We are fighting to keep other women safe. If we are heard, we will succeed and save
lives.

KNOW THAT YOUR VOICE CAN MAKE A DIFFERENCE, PLEASE SIGN AND FORWARD THIS EMAIL TO EVERY WOMAN IN YOUR LIFE.

Note from Maven:

For women living in Nevada, remember that GOP/TeaParty candidate running for the U.S. Senate, Sharron Angle, has declared she would oppose any type of mandate regarding cancer screening - that even includes mammograms. She would obviously oppose this important life saving measure as well.

Are you dense? Be aware of the cancer risk you haven't heard of

A breast cancer patient that I’ve been corresponding with back east sent me this fascinating information linking breast tissue density and breast cancer. She has been ‘dogging’ this issue because, like me, she had very dense breast tissue which not only may of delayed the discovery of her breast cancer, but may have been an indicator of increased risk of breast cancer.

For many years, I was told how unusually dense my breast tissue was (“Yes, thanks. Ouch. I know.”) and that it make good clear mammograms difficult. I didn’t even realize that it might have pointed to an increased risk of developing breast cancer.

Fortunately, the state of Connecticutt is trying to do something about it, and has passed a law (P.A. 0941) that will inform women of breast density issues and what it may indicate for further screening and testing. This is a very positive step toward finding breast tumors before they become advanced - in my case Stage IIIa and dangerous.

Note:

If you are a woman in Nevada, remember that the GOP/TeaParty candidate for U.S. Senate, Sharron Angle, doesn’t believe that insurance companies, and certainly the state, should be mandated to do anything like what Connecticutt is doing. She would fight this on a national level, if elected. She has publicly opposed any sort of cancer screening mandates that save lives.

Here is an email, my contact, Teresa, received from the folks battling to get women this extra measure of care:

Hi. Thank you for writing to me - and sharing our common story.  I hear stories from women like us so often - that is why we do this work - as we need to ensure that the medical community TELLS women about their breast density. 

JoAnn Pushkin of New York has a similar story as ours - she is working with Senator John Flanagan of New York to enact a state bill similar to CT - and Congressman Steve Israel to sponsor legislation on the federal level.  You can contact her as she is garnering support of the bill.  Your support and assistance would be great - our stories are compelling and will lead to action.  

Her email is jpp@optonline.net. 

Stay well,

Nancy

Nancy M. Cappello, Ph.D.
President and Founder
Are You Dense, Inc.



A 501(c)(3) Public Charity

Follow Are You Dense on Facebook

Founding Member of D.E.N.S.E. (Density Education National Survivors’ Effort)

And this is a good article:

“It just might be the greatest cancer risk you’ve never heard of.”

Los Angeles Times

“Breast density linked to Cancer Risk”

Karen Ravn, 6/21/2010

BREAST DENSITY FACTS

• 2/3 of pre-menopausal and ¼ of post menopausal women have dense breast tissue
• Cancer is 5 times more likely in women with extremely dense breasts
• A mammogram will find only 48% of tumors in women with the densest breasts (and therefore elude early detection)
• Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer
• Cancer recurrence is four times more likely in women with dense breasts

If a mammogram is supplemented with an ultrasound or MRI,

tumor detection rate increases at least 30%

The vast majority of women are utterly unaware of their own breast density.  A May 2010 national survey conducted by Harris Interactive found that 95 percent of women ages 40+ do not know their breast density and nearly 90 percent did not know it increases the risk of developing breast cancer. Why? Their doctors have never had a conversation with them about it.

Connecticut has passed a law (P.A. 0941) which dictates that :

 “all mammography reports given to a patient on and after October 1, 2009 to include information about breast density. When applicable, the report must include the following notice: If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening or a breast MRI examination, or both, depending on your individual risk factors”.

Raising awareness of breast density will increase the detection of early stage cancers – when they are most treatable. We would like to see similar law passed based on the groundbreaking legislation in Connecticut.

Update on Saturday, October 23, 2010 at 22:14 by mavenandmeddler

BlueLyon mentioned Renown having new 3D Ultrasound technology. Here’s the website information:

Renown Health believes early detection is crucial to breast health. At Renown, you will receive the highest level of care with a team of highly trained physicians, nurses, and technologists and the most advanced technology and digital mammography.

INTRODUCING THE REGION’S ONLY 3D BREAST ULTRASOUND
Renown Breast Health Center now offers northern Nevada’s first and only 3D breast ultrasound, SonoCiné, a new technology that more accurately detects small cancers in women with dense breast tissue (40% of women seeking mammograms have dense breasts). This technology is approved by the FDA as an adjunct exam to mammography. When SonoCiné is added to mammography, 60% - 100% more cancers are detected. These small cancers, not found by mammography, would otherwise be missed until they are larger and less treatable. Learn more about SonoCiné.

Research shows early detection can increase breast cancer survival. Breast cancer screening can involve a number of different types of examinations, which include breast self examination, clinical breast examination, mammography, magnetic resonance imaging and ultrasound. Mammography can detect cancer in its earliest stages – even before it can be felt during a physical breast examination.

Click here to schedule a mammogram or for more information about 3D breast ultrasound.

Renown Health offers two convenient mammogram locations. Call 775.982.8100 to schedule a mammogram
Renown Breast Health Center 901 E. 2nd Street, Reno	X-Ray & Imaging 6630 S. McCarran Blvd., Reno

Breast density and your risk of breast cancer

When I saw this report, I turned to my husband and said “well, now there’s a real news flash.”

I battled confusing mammograms and ultrasounds for years due to very dense breast tissue. One time, during an ultrasound, the radiologist simply put the wand down with a big sigh, and told me that he had counted over 30 supposedly benign masses and there were at least that many more. He saw no reason to continue. He said to go home and not worry about it.

Click to read more ...