Know Your Body. Understand Your Options.

 

Are you dense?

Dense breasts are normal; up to 40% of American women have them. It simply means that you have more fibrous, glandular breast tissue in your breasts than fatty tissue. Younger women typically have denser breast tissue. As women age, and especially after menopause, their breast tissue becomes less dense. If they take postmenopausal hormones, their breasts may remain dense.

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Breast density is measured during your annual screening mammogram

All mammography reports from our center contain a classification of breast density based on the Breast Imaging-Reporting and Data System (BI-RADS) breast composition categories:

breast density

 

Why is breast density important?

While the reasons are not yet fully understood, women with denser breasts are at an increased risk for breast cancer. In addition, clinical studies have shown that women with dense breasts can benefit from a supplemental form of screening in addition to mammography.

 

Supplemental screening

For women classified as BI-RADS 3 (heterogeneously dense) and BI-RADS 4 (extremely dense). Supplemental screenings can include breast MRI and 3D Automated Whole Breast Ultrasound (ABUS).

Breast MRI is generally recommended for women who are determined to be at high risk for breast cancer (e.g. another family member was diagnosed with the disease). For most women ABUS is a less expensive and highly accurate form of screening. The Invenia™ ABUS used at Desert Rose Women’s Center has been clinically proven to improve breast cancer detection by 35.7% over mammography alone, and is especially useful at detecting smaller and earlier stage cancers in women with dense breasts.

 

Why haven’t I heard of breast density before?

The issue of breast density has only recently emerged into the national spotlight, and the majority of clinical research on the subject is less than ten years old. Just seventeen states have breast density notification laws, but that number is growing. While New Mexico does not have such a law in place as of yet, we at Desert Rose Women’s Center feel strongly that this is an important issue that both doctors and patients need to know about.

The clinical evidence is clear, and this is not a medical “fad.” Breast density is not only a risk factor for breast cancer, but it can also impact a woman’s ability to achieve early detection using traditional methods. It is widely agreed that early detection is the key to surviving breast cancer, so any issue that can impact a woman’s confidence in her healthcare strategy must be considered.

Learn the facts for yourself. Talk to your doctor. If you need more information, we are here to help.

 

Clinical Studies Supporting Automated Whole Breast Ultrasound (ABUS)

The following are a list of clinical studies demonstrating the viability of ultrasound as a breast cancer screening tool:

Automated Whole Breast Ultrasound (ABUS) clinical studies

Note.-a = Density of breast parenchyma on mammogram according to gradation of American College of Radiology BI-RADS protocol on scale of 1-4: type 1, breast is almost entirely fat; type 2, there are scattered fibroglandular densities; type 3, breast tissue is heterogeneously dense; and type 4, breast tissue is extremely dense breast. b = Not included are another 867 examinations performed in women with abnormal mammographic or physical finding. c = Not included are another 1354 examinations performed in women with abnormal mammographic or physical finding. d = 318 women at high risk of breast cancer were included, e = Women with abnormal mammographic findings were included. f = All women were at high risk of breast cancer. g = In published series (31), 35 invasive and 5 noninvasive cancers with mean size of 9.1 mm were detected with sonography in women including symptomatic group. h = In published series (8), 36 invasive and 1 noninvasive cancers with mean size of 9.9 mm were detected with sonography in women including group with abnormal mammographic or physical findings. i = 8 of 9 participants with staging

 

Study conclusion highlights:


 

Buchberger et al, 2000

The use of high-resolution sonography as an adjunct to mammography in women with dense breasts may lead to detection of a significant number of otherwise occult cancers that are no different in size from nonpalpable mammographically detected cancers. Prospective classification of these lesions based on sonographic characteristics resulted in an acceptable benign-to-malignant biopsy rate of 6.3:1.


Kaplan, 2001

Bilateral whole-breast US, when performed in patients with dense (BI-RADS category 3 or 4 density) breast tissue, is useful in detecting breast cancer not discovered with mammography or clinical breast examination. The 0.3% cancer detection rate compares favorably with that of screening mammography and with that in previously published studies involving bilateral whole-breast US.


Kolb et al, 2002

The sensitivity of ultrasound averaged 75% in patients with dense breasts (grades 2 through 4). When ultrasound and mammography were combined, there was 100% sensitivity in grade 2 breasts. The combined sensitivity of mammography and ultrasound in grades 2 through 4 was 97%.


Crystal et al, 2003

Screening breast sonography in the population of women with dense breast tissue is useful in detecting small breast cancers that are not detected on mammography or clinical breast examination. The use of sonography as an adjunct to screening mammography in women with increased risk of breast cancer and dense breasts may be especially beneficial.


Leconte et al, 2003

Leconte[16] examined 4236 patients with both ultrasound and mammography. They noted that mammography detected 80% of cancers in grade 1 and 2 breasts, while sonography detected 88% of cancers. In grades 3 and 4, the sensitivity of mammography decreased to 56%, while sonography remained stable at 88%.

Conclusion: Sonography is a useful adjunct after mammography for the detection of nonpalpable breast cancer, particularly in the dense breast


Corsetti et al, 2008

The study confirms the possibility that ultrasonography can detect mammographically occult breast carcinoma in dense breasts. The evidence is insufficient to recommend this policy in routine screening practice but suggests that, at least in current clinical practice, adding ultrasonography in dense breasts may be useful despite the substantial costs.


Berg et al, 2008

Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives


Nothacker et al, BMC Cancer 2009, 9:335

Supplemental breast ultrasound in the population of women with mammographically dense breast tissue (ACR 3 and 4) permits detection of small, otherwise occult, breast cancers. Potential adverse impacts for women in this intermediate risk group are associated with an increased biopsy rate


Merry, et al, 2013

Handheld screening breast ultrasonography has been shown across multiple studies of patients with dense fibroglandular tissue and/or increased risk of breast cancer to have an average breast cancer detection rate of 3.7 additional cancers detected per 1000 women screened


TEC, Assessment Program, Volume 28, No. 15, April 2014

Special Report: Screening Asymptomatic Women with Dense Breasts and Normal Mammograms for Breast Cancer

Women with dense breasts on mammography are at higher risk of breast cancer and of having any cancer missed by mammography. One possibility is to use additional imaging for women with dense breasts and normal mammograms.

Links & Resources

For more information, please visit the following:

 

AreYouDense?

A Leading National Resource for Women with Dense Breasts

 

American Cancer Society

“Breast Density and Your Breast Mammogram Report”

 

National Cancer Institute

“What is the Breast Imaging Reporting and Database System (BI-RADS®)?”

 

Komen

“Facts for Life: Breast Density”