Normally asking someone "are you dense?" may come across as insulting, but the question - when it relates to a woman's breast tissue - may be lifesaving.
Most women imagine getting breast cancer as a randomly occurring "bad luck" event. The truth is that the risk for developing breast cancer can be very accurately calculated.
It is important for a woman to know her risk of developing breast cancer because if her risks are high, effective diagnostic steps can be taken to identify cancer in its earliest stages. Furthermore, medicines are available to markedly reduce development breast cancer.
Most women know some of the risk factors of breast cancer, but they are not able to separate the major risk factors from the minor risk factors. Minor risk factors including weight, tobacco and alcohol use and reproductive history have very little impact on breast cancer risks. Major risk factors, on the other hand, significantly increase the risk of breast cancer.
A strong family history of breast cancer, the use of hormone therapy, a BRCA genetic mutation, or premalignant tissue changes on a prior breast biopsy are major risk factors for breast cancer. Increased breast imaging is important for women with any of these risk factors.
However, increased breast tissue density is the only major risk factor that is associated with a reduced accuracy breast examination and in mammography. Cancers in dense breasted women are difficult to feel on examination and to see on a mammogram.
As a result, these women are under the threat of a "perfect storm" when it comes to the identification of breast cancer because they are not only at increased risk for developing a breast cancer but routine breast testing is not capable of recognizing many of breast cancers they may develop.
For women caught in this "perfect storm," breast ultrasound is a great help in identifying breast abnormalities because the ultrasound waves are capable of identifying tiny cancers even in very dense breast tissue. By adding ultrasound testing to women with dense breast tissue, small breast cancers can be easily identified, treated and cured.
Breast density usually is defined as one of four categories:
Entirely fat - very little density;
Scattered fibroglandular densities - minimally dense;
Heterogeneously, or moderately dense; and
If a woman's density falls in one of the latter two categories, she should consider having a relatively new test called "Whole Breast Ultrasound." The test is painless. However, it requires considerable skill and experience on the part of the technologists performing the procedure in order to be in any way accurate.
We encourage all women over the age of 40 to have a mammogram yearly. Each woman should be told the result of their mammogram and the density of their breast tissue.
If density is not mentioned in the report, a woman should demand that the mammogram be read again in order to provide an accurate assessment of breast density.
If breast density is determined to be moderately (50 percent to 75 percent) or extremely dense (75 percent to 100 percent), whole breast ultrasound at an experienced center should be requested.
To arrange for a whole breast ultrasound, call the Kathryn Candor Lundy Breast Health Center at 326-8200.
Dr. Timothy Pagana is medical director of the Susquehanna Health Kathryn Candor Lundy Breast Health Center.