SOMETIMES WHAT YOU CAN'T SEE

Nearly half of women have a characteristic that can increase their risk of breast cancer: dense breasts. One in eight women will develop breast cancer over our lifetimes. But women with the densest breasts can be four to six times more likely to develop breast cancer than women with the least dense breasts, according to the American Cancer Society.

What's more, dense breast can make tumors more difficult to detect on a mammogram. "With increased breast density, the concern is the masses could be obscured by the dense tissue," explains Caroline Kilian, MD, a board-certified women's imaging specialist at SMIL Medical Imaging. An easy way to imagine dense breast tissue is as clouds in the sky with breast cancers as white planes in flight. When a plane flies through wispy clouds, you can still see the plane in the air, but when a plane flies through thick clouds, it can be nearly impossible to detect.

Dense breast tissue is very common but, in the past, the topic perhaps hasn't gotten the attention it deserves. But that's changing. Since 2009, 36 states - including Arizona - have passed legislation requiring radiologists to inform patients if a mammogram reveals they have dense breasts. Physicians often recommend that women with dense breasts get a specific type of mammogram and sometimes additional imaging. So, it's essential to be aware of your breast density so you and your medical provider can discuss the best screening options for you.

What is breast density?

Dense breasts contain more glandular and fibrous connective tissue compared to fatty tissue. You can't tell how dense your breasts are based on how firm or lumpy they feel. Fatty and dense breasts can both feel lumpy, since ligaments can wrap around fat lobules, making them feel like squishy grapes. Lumpiness can also be caused by extra fluid in the breasts during menstruation.

Nearly half of women over age 40 have dense breasts and it is a normal finding. But your breasts are unique and can change over time. Breast density often decreases after menopause. Fewer than 30 percent of women in their 60s, and 25 percent in their 70s have dense breasts.

How do I know how dense my breasts are?

The only way to reliably determine breast density is through a mammogram. It is often recommended that women start getting annual mammograms at age 40 and all guidelines agree you should talk with your health care provider. After a SMIL mammogram, you will receive a report that includes as assessment of your breast density. Each woman's breasts are different and contain a unique mix of fatty and dense tissue. Some women's breasts are almost all fat, some have very little fat, and some are in between.

Radiologists classify breasts in one of four categories:

A- Fatty: The breasts are almost entirely composed of fat. About one in 10 women has fatty breasts.
B- Scattered areas of fibro glandular density: The breast is mostly fatty, laced with some dense areas. About four in 10 women have this result.
C- Heterogeneously dense: Though there are some areas of fatty tissue, the majority of the breast tissue is dense. About four in 10 women have this result.
D- Extremely Dense: Nearly all breast tissue is dense. About one in 10 women has extremely dense breasts.

When doctors say a woman has "Dense Breasts," she falls under the heterogeneous or extreme categories. But while the mammogram image may be black and white, people's judgements are not. Two physicians looking at the same image might classify density differently, especially between categories B and C. So artificial intelligence is being developed that uses algorithms to determine density. Since radiologists are better than machines at gauging certain nuances of mammograms, artificial intelligence is not meant to replace humans but be used as a second opinion.

What should I do if I have dense breasts?

Dense breast tissue is white on the mammogram and the fatty tissue is dark on a mammogram. Cancers tend to be white spots on a mammogram. If a cancer develops in an area of dark ft it may be easier to detect even when it is small. But if you have a lot of dense (or white) breast tissue on your mammogram it can be hard to see that white cancer, sort of like looking for snowball in a blizzard. "So, a lot of patients with dense breasts talk to their providers about whether they should get an ultrasound in addition to a mammogram," Kilian says. "You never want to completely replace a mammogram with an ultrasound. Ultrasound can't pick up things like microcalcification which is a form of carcinoma or even an invasive cancer."

Another test that may be recommended, especially for women already at high risk for breast cancer, is an MRI. Ultrasound or MRI when added to mammography have been shown to increase the detection of early-stage breast cancer in women with dense breasts. However, both show more findings that may not be cancer, which can be a result in added testing and unnecessary biopsies. It should be pointed out that not all insurance companies will cover the cost of these additional tests on the basis of dense breast tissue alone and you should check with your insurance company. You may also want to talk to your provider about 3D mammography which can improve that chance of finding cancer in most breasts. "3D mammography is a big help for looking through dense breast tissue because it shows slices of the breast, so you can look the slices and see if anything pops out in the wat of a mass or distortion," Kilian explains. "Also, 3D increases the detection of invasive cancers and decreases callback rates. I personally would recommend it to any of my friends and family."

SMIL Medical Imaging used the Genius #d Mammography exam, the only FDA-approved technology with proven superior performance for women with dense breasts, compared to the traditional mammography. State-of-the-art equipment can become even more effective when its used by experts. Some facilities, including SMIL. Have specialized breast imaging radiology physicians. A 2018 study from Brigham and Women's Hospital in Boston found that accuracy was higher when mammograms were read by experienced breast imaging specialists. As part of your routine mammogram at SMIL Medical Imaging, both your breast density and personal risk are measured. These factors help you and your health care professionals decide which screening options are best for you. And remember: IT's very important not to ignore a lump or any changes in your breast just because your recent mammogram was normal. That's especially trust if you have dense breasts.

For more information, visit eSMIL.com or Densebreast-info.org