Understanding Breast Density - Professor Wendy Ingman

arpie

Mammograms are a fantastic tool for identifying many breast cancers - However, having Dense Breast Tissue can result in a later diagnosis as tumours don't always 'show' on 2D mammograms for women with more dense breast tissue, until they are larger & more dangerous.  Sometimes dense breasts are also called 'lumpy breasts'.    Mine were - but I was never told of the increased risk of delayed diagnosis of Breast Cancer.  My own tumours were found 4 months after a 'clear' mammogram - when my GP suggested she check my breasts.

Breast Density 'masks' Breast Cancer.  A delayed diagnosis can lead to larger, more dangerous tumours and may even be Stage 4 at diagnosis due to not being picked up on previous mammograms (and I'd had about 10 - as I'd been 'called back' a few times, but never really told why.) 

Dense tissue shows as 'white' (or occult) on the mammogram, and tumours show as 'white' as well.  

White on White = unable to detect the tumour with a 2D mammogram.  (3D Tomosynthesis machines are better at picking up dense breast tissue - but are not commonly available at Breast Screen clinics.)

There is a need for Breast Screen clinics to advise women of their breast density - but currently only Western Australia Breast Screen actively advises their clients of their breast density.   

An Ultrasound is recommended for anyone with dense breast tissue - and biopsy on any suspect areas.  Tell your daughters, sisters & any other woman who SHOULD KNOW THIS as a 'right'!!   

https://www.youtube.com/watch?v=6BJeLEjs2q4

Nefertari

So true Arpie, I found this out about 14 years ago from my Sister when she was diagnosed with BC.  She has dense breasts, her mammogram was clear and it was only detected by ultrasound.
I had to have my mammogram around the same time and asked if I have dense breasts, yes. So I had an ultrasound also- recommended by my GP.
Funny thing is, this time around my Surgeon said my breasts are no longer dense, I did not know that was even possible?

arpie

Wendy mentions the change in breast density thru the years - also relative to having children and aging.

It can be hormonal as well as genetic, I think - hence women on HRT have a higher chance of BC as their hormones have been manipulated.   

I was on hormone cream for some months in my 50s & had a mammogram at that time - and received a callback to the local bus, then to the closest town ..... then to John Hunter Hospital in Newcastle!  It was believed to relate to the testosterone component of the cream!  I stopped the cream as soon as I got the callback to John Hunter & by the time I was checked again there - it had gone back to relatively normal again!  (No mention of dense breast tissue there, either, even tho a specialist had told me in my 20s that my breasts were 'lumpy'!)

Afraser

My surgeon says all breasts get less dense as we age - mine is apparently transparent! 

arpie

I'm getting older & mine are still dense. 

I didn't have kids either - apparently having kids makes them less dense as well

I don't think they really 'know', to be honest

Shakalker

I have always had dense breasts, but have noticed a change in them since being on chemo.
It seems like my remaining boob is softer and floppier than it used to be.

Afraser

Perfectly true that you may still have dense breast tissue when older -  whether it fractionally less dense than before is one of those interesting academic questions!

From the Mayo: It's not clear why some women have a lot of dense breast tissue and others do not.

You may be more likely to have dense breasts if you:

• Are younger. Your breast tissue tends to become less dense as you age, though some women may have dense breast tissue at any age.
• Have a lower body mass index. Women with less body fat are more likely to have more dense breast tissue compared with women who are obese.
• Take hormone therapy for menopause.Women who take combination hormone therapy to relieve signs and symptoms of menopause are more likely to have dense breasts.

arpie

And another video re Dense Breasts

https://m.youtube.com/watch?feature=youtu.be&fbclid=IwAR2-VX1jjzqG2et1bGW37S35iR4xjMQYA9bXya3rjdikXWXxRb5qVmS43pE&v=eCu4vU-fd3M

CRM

Is a contrast mammogram the same as 3D mammogram or is that different?  I had a contrast mammogram during my original diagnosis and have another contrast mammogram scheduled for end of January.  I umm'd and ahh'd between the MRI and the mammogram because I think the MRI is better technology but my surgeon didn't seem to think it made a lot of difference which scan I have.  I think the contrast mammogram is relatively new and improved and becoming more common (in Melbourne but not sure about Australia-wide).  

arpie

@JoeyLiz - can you help with this question re Contrast Mammogram vs 3D mammogram, please?  I am not familiar with the term.

Hmmm, I wonder if it was your surgeon's mother/sister/wife/daughter if he would forego the MRI?  I think not - particularly if it is Invasive Lobular, which is harder again to identify anyway!

JoeyLiz

@arpie apologies but I am not familiar with contrast mammogram sorry. Contrast is injected for scans such as CT and MRI and make certain things stand out more but never heard of it for mammograms

arpie

@CRM Can you describe what the Contrast Mamogram entailed, please?

many thanks

CRM

Yes, that's it.  They injected contrast in me before the mammogram.  I think it is fairly new and supposed to be as good as the MRI.... but who knows.  I thought that might be a 3D mammogram but it's probably something different. 

CRM

According to google it is called 'contrast enhanced spectral mammography (CESM).' 

arpie

Wow!  @CRM ...  
Better for those that are claustrophobic, eh?
where did you have it done?

CRM

@arpie It was at Royal Melbourne Private Imaging.