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Cancer Harder to Detect in Women with Dense Breasts

by Tracy Maness

Publication: Houston Chronicle

Women with denser breasts not only have slightly higher risks for developing breast cancer, but also the cancer can be harder to detect on their mammograms, according to a breast oncologist.

In March, the Food and Drug Administration proposed standards for mammography that require providers to give their patients better information about breast density. The new regulations are the first changes to mammography screening requirements in more than 20 years.

However, Texas providers have been ahead of the game in providing the breast density information to patients since a state bill requiring better education was passed in 2011. Texas is was one of 36 states doing so prior to the new national standards.

Dr. Michelina Cairo is a breast oncologist at Texas Oncology-Houston Memorial City and shared some thoughts to help women understand what they should know about dense breasts.

“Breast density refers to how the breasts look on mammograms. So breast density is not something that you can feel necessarily during your self-breast exam and not even necessarily your physician can feel,” Cairo said. “We can get a hint sometimes: if breasts feel very dense or very nodular, that can be a hint that they’re also mammographically very dense. But it’s really only something that you can detect on breast imaging, on mammograms.”

She said although sometimes breasts that feel very dense or nodular can be indicator, the only way to definitively detect dense breasts is by doing a mammogram.

“Breast density is important to us because dense breasts can sometimes hide a cancer because the breast that would be ideal for mammography would be breasts that have been fatty-replaced,” Cairo explained. “So most women who’ve gone through menopause rather than having the lobules that make the milk, the ducts that carry the milk to the nipple, that’s not so useful to them any longer. And so fatty tissue has replaced that.”

Fatty tissue is more ideal for mammograms because the X-rays go through it making appear dark, so a cancer spot that is very dense or very bright will stand out better, Cairo said. She said younger women, premenopausal women and older women with denser breasts tend to have more dense spots.

Cairo said in addition to an increased chance of having cancer missed in mammograms, women that have dense breasts seem to have a bit of an increased risk that they will develop breast cancer. She said research points to characteristics that make breasts denser can cause changes that can lead to breast cancer.

Women 40 years and up as well as younger women with breast cancer risk factors like a family history of early breast cancer and known genetic mutations that can lead to breast cancer should get routine screenings, Cairo said. “Early detection leads to cures,” and helps women avoid having to go through as many of the difficult treatments like chemotherapy, medicines and surgeries.

Cairo wanted to add that there is also no point that older women age out of needing to get their annual mammogram.

She said women with denser breasts can often be eligible for additional screening using an MRI, which can be done once a year, alternating with a mammogram so that the women get screening services every six months.

The new FDA proposed standards also require mammography facilities across the country to undergo inspections to ensure minimum standards.

Since Texas has required better patient education about breast density eight years before the federal government did, Cairo gave props to its lawmakers back then who she said decided to make women’s health a priority.

“I have to credit the Texas legislature for passing House Bill 2101, which we call Henda’s Law, and in really paying attention to scientific literature suggesting that breast density is an increased risk factor.”

Read the full story at Houston Chronicle.

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