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What Are Dense Breasts? | Q&A

What Are Dense Breasts? | Q&A

[MUSIC] Dense breasts, basically
the breast tissue is made up of two main categories,
gland tissue and fat. And the gland tissue is what
produces milk for the baby. So that is the tissue, actually, that can turn into
cancer also, and fat does not. And every woman has kind of a
unique balance of the gland and the fat tissues. Everyone is different, no one is
really the same as anyone else. The women who have a lot
of gland tissue and very little fat,
we call that a dense breast. [MUSIC] The term dense breasts really
refers to the way the breast appears, on a mammogram. So, it really has nothing to
do with whether your breasts are lumpy or whether they’re
sore, or their size. It’s basically, what does it
look like on the mammogram? So, it’s a mammographic
definition. [MUSIC] The breast density is important
because the breast is an active gland that’s constantly,
before menopause anyway, for women who are young, before
they’ve gone into the menopause. The gland tissue of the breast
is very active in its producing glands that would support the
ability to make milk for a baby. With each menstrual cycle that
develops, the breast tissue develops and then regresses if
the woman does not get pregnant. So this is a constant
change going on throughout the menstrual cycle. And because of that, because the
breast tissue has this ability to produce new cells, sometimes
some change actually becomes abnormal and
that’s what cancer is. Cancer is change that has
abnormal growth that’s kind of out of control. That’s what cancer is. And so we are looking for
the cancer in the gland tissue. We’re looking for mistakes that
happened in the gland tissue. And that’s that
denser gland tissue. [MUSIC] That’s actually true, that a
denser breast is more difficult to detect the cancer
on a mammogram. The mass is in the dense
gland tissue, and if there’s fat surrounding
that gland tissue, it’s much more easy for
us to see a mass, which is white on the mammogram,
against the dark background. But if the gland
tissue is dense, that means that the mammogram
is white, and we have a cancer, which is white,
against a white background. If you kind of think of
a polar bear in a snowstorm, it’s kind of hard to see
that polar bear, and the same thing can be true
with a mass in a dense breast. It can be obliterated or made very difficult to see by
the surrounding gland tissue. And interestingly, something else that’s
come up more recently, not only is it more
difficult to detect. But actually women with dense
breasts have an increased risk of getting breast cancer
compared to women who don’t have a dense breast. [MUSIC] So radiologists use the breast
density information to help guide whether or not we need
additional information, more than just the mammogram,
in order to screen for breast cancer. So we have other tools
other than the mammogram, the mammogram is always
our number one choice for women over 40. But we can also add, we can add
ultrasound, we can add MRI, and we can actually add something
called molecular breast imaging. These are not limited
by breast density, the way the mammogram is. [MUSIC] 3D mammography is a big help
in diagnosing breast cancer. We’ve actually found our
information has what we’ve been doing in practice at Johns
Hopkins is really very much similar to what’s been
shown in the literature. Which is a 40% increased
detection of breast cancer on a 3D mammogram as compared
to the standard mammogram. So we like it very much,
it’s a big help. Basically, what 3D mammography
does is give us one millimeter thin sections, so we’re peeling
back layers of the mammogram. Rather than looking through
a thick slab of tissue, we’re getting very
thin sections. And that’s a big help in trying
to find these early cancers. [MUSIC] Radiologists actually use four
different levels of breast density to categorize what
the mammogram looks like. So we have the extremely dense, and then we have what we
call heterogeneously dense. Then we have, on the other
end of the spectrum, we have fatty breast. Almost completely fatty. And then we have what we call
scattered fiber glandular densities. So starting from the fatty end,
it’s basically about 0 to 25% gland tissue on
the mammogram that’s fatty. Between 25 and
50 we call scattered fiber glandular densities. The terms are somewhat
unwieldy but they work for us. And then between 50 and
75% approximately, we say heterogeneously dense,
and if you’re more than 75% dense,
we call that extremely dense. [MUSIC] We really can’t change
our breast density, it’s not really a choice. It is what it is. Some women are dense,
and some women are not. It does sometimes change
as we get older, so an older woman is more likely
to be more fatty breast tissue. The younger woman is
more likely to be dense. Very thin women who
don’t have any fat, they’re more likely to be dense
than a woman who is overweight, has more fatty tissue. But it’s not something
that we can control. [MUSIC] The reason we’re now letting
women know about their breast density is that it can help
you make an informed decision, you and your doctor, about
whether you need more than just the mammogram to screen for
breast cancer. If you’re extremely dense, maybe you want to think about
a screening ultrasound or even a screening MRI. We try to limit the screening
MRI to women who are at elevated risk of breast cancer,
either due to very strong family history in first
degree relatives, or women who may even have
the breast cancer gene. [MUSIC]

2 comments on “What Are Dense Breasts? | Q&A

  1. I had dense breasts until several mammograms later the nurse made sure to push the mammogram down so hard I screamed. Now instead of breasts I have 2 pillows. No shape at all. No breast cancer in my family 4 generations on both sides. Now my breasts are ruined. It's not right.

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