How to manage breast cancer risk in women with dense breasts

In recent years, a lot of effort has been placed on increasing awareness about breast cancer and the steps you can take to minimise its impact. This is largely due to the fact that today, breast cancer is the most common cancer to affect women around the world. It is also easily treated in its early stages. Regular breast cancer screenings and awareness about risk factors can go a long way in minimising the impact of breast cancer. 

Breast density is one of the risk factors that is detected on a mammogram. But what does it mean to have dense breasts? Does it really increase the risk of breast cancer? What should be done after being diagnosed with dense breasts? In this article, we will explore the answers to some such questions related to breast density. 

What is breast density?

Before we define breast density, let us look more closely into the structure of the breasts. Breasts are made up of three types of tissue. These are:

• Fibrous tissue: Holds the breast tissue in place.
• Glandular tissue: Comprises of lobes and ducts that produce and carry milk to the nipple. 
• Fatty tissue: Responsible for the shape and size of the breasts. It fills the space between fibrous tissue, lobes and ducts. 

Breast density is the amount of fibrous and glandular tissue in the breasts compared to the amount of fatty tissue. 

How is breast density classified?

Based on the mammogram report, breast density is categorised into the following grades:

• Almost entirely fatty (A): This indicates that the breasts are almost entirely made up of fatty tissue. About 10% of women have fatty breasts.
• Scattered areas of fibroglandular density (B): Scattered areas of density can be seen on the mammogram. However, the majority of the breast tissue comprises of fatty tissue. Around 40% of women have scattered areas of fibroglandular density.
• Heterogeneously dense (C): Some areas of the breasts comprise of non-dense or fatty tissue, while the majority of the breasts are made of dense or fibroglandular tissue. Around 40% of women have heterogeneously dense breasts.
• Extremely dense (D): Almost the whole breast is made of fibroglandular breast tissue. Around 10% of women have extremely dense breasts.

Women with heterogeneously dense or extremely dense breasts are considered to have dense breasts. 

Dense breast tissue cannot be felt in a physical or self-examination. It is detected only on a mammogram. The dense tissue appears white on a mammogram while fatty tissue appears dark.

What causes dense breasts?

The factors which contribute to dense breasts are still unclear. However, some of the causes that can increase the chances of having dense breasts include:

• Age- Breast density is seen to reduce with age (barring exceptions).
• Lower BMI- Women with lower body mass index (less body fat) are more likely to have dense breasts. 
• Undergoing any form of hormone therapy for menopause- Breast density may increase for women undergoing hormone therapy for their menopause symptoms.

Watch the video as Dr. Rohan Khandelwal, Breast Cancer surgeon in CK Birla Hospital, Gurgaon talks about the relationship between Breast Density and Breast Cancer.

What are the implications of dense breasts?

Breast density is an important part of managing your breast health as well as developing your breast cancer screening plan. 

Breast density makes it harder for the radiologist to detect anomalies or signs of breast cancer in the mammogram. This is because early cancers, which show up as white dots or masses in the mammograms are masked by the dense breast tissue (which also appears white). Studies show that mammograms can miss almost half of the cancers in women with dense breasts. Women with dense breasts are also more likely to be detected with cancer after getting a normal mammogram report (after other symptoms of breast cancer start appearing such as lumps). 

Apart from this, dense breasts are also associated with a higher risk of breast cancer. The reasons for this are still unclear. For women in category C of breast density, the risk of breast cancer is almost 1.5 times that for women with mostly fatty breasts. For women in category D, the risk of breast cancer is almost double that of women who have a mix of dense and fatty breast tissue. 

Read: Worried about an underarm lump? Find out what it means

What to do if you have dense breasts?

It is important to remember that dense breasts does not necessarily result in breast cancer. Breast cancer is often caused by a complex interplay of risk factors.

• If you have been diagnosed with dense breasts in your mammogram, you may be asked to undergo a secondary imaging test along with your mammogram as a part of your routine breast cancer screening. 
• Some of the most common options of supplemental screening include Ultrasound, Breast MRI etc. 

The most important steps to keep in mind if you are diagnosed with dense breasts are:

• Get annual mammograms without fail with supplemental screening if required
• Perform monthly breast examinations (Learn how to perform breast self-examination)

Follow lifestyle recommendations to minimise the risk of breast cancer such as maintaining healthy body weight, limiting your consumption of alcohol, not smoking and exercising regularly. 

While breast density is out of our control, the above steps can help you minimise other risk factors. For more information about breast cancer and to assess your risk, you can consult Dr Rohan Khandelwal, one of the best breast cancer specialist in Delhi NCR. 

Book an appointment with Dr Rohan Khandelwal.

Read: Breast cancer: warning signs and how do you minimise your risk?