Article: Dense breasts and mammograms: Jill Goodacre’s story

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Breat density in the news

Screening and breast density concerns were in the news recently when former Victoria’s Secret model Jill Goodacre shared her story with People magazine about her breast cancer diagnosis. Goodacre says she went in for a routine mammogram, and even though it came back clear, her doctor recommended additional testing. “They said, ‘Okay, looks good. Since you have dense breasts, just go across the hall for your sonogram,’” she said. But even though her mammogram didn't find anything unusual, the sonogram (ultrasound) found a suspicious-looking spot. Goodacre then had a biopsy, which determined that she had stage 1 invasive ductal carcinoma, a form of breast cancer. She underwent treatment and reported that now, 5 years later, she is doing well.

What does it mean to have dense breasts?

Breast density reflects how much of the breast consists of fatty tissue, and how much is comprised of glands, ducts, and other non-fatty, fibrous tissue. Dense breasts contain less fatty tissue. Because they don’t look or feel differently, without mammography, there's no way of knowing if your breasts are dense. On a mammogram, fatty breast tissue appears dark, while denser tissue looks white.

What affects breast density? 

Breast density varies greatly by age and weight. Dense breasts are more common in both young and thin women. High breast density is common,in the U.S., 40-50 percent of women ages 40-74 have dense breasts.  

• About 50-60 percent of women ages 40-44 have dense breasts, compared to 20-30 percent of women ages 70-74.
• About 50-60 percent of healthy-weight women have dense breasts, compared to 20-30 percent of obese women.

Medications that contain hormones can also affect breast density. For example:

• For postmenopausal women, taking hormone replacement therapy (HRT) may increase breast density.
• For women at higher risk of breast cancer, taking the risk-lowering drug tamoxifen tends to decrease breast density.

What role do mammograms and other screening methods play for someone with dense breasts?

Dense breasts and breast tumors both appear as white areas on a mammogram, often making it difficult to differentiate between the two; if you have dense breasts, it can be easier for cancer to go undetected by routine mammograms. Having dense breasts is also thought to slightly increase a woman’s risk of developing breast cancer, but researchers don’t know why. 

After a mammogram, you’ll get a report which may or may not mention breast density. According to the American Cancer Society, states have different laws about whether or not mammogram reports need to include information on breast density. Almost half of U.S. states include information on dense breasts with mammogram results. Depending on the density of your breasts and  other risk factors, your doctor may recommend additional screening by 3-D mammogram, ultrasound, or MRI.

Dense breasts are common, but there are no set guidelines about additional testing for people who have them. “There’s no standard—the guidelines are all over the place,” Richard Reitherman, M.D., Ph.D., Medical Director of Breast Imaging at MemorialCare Breast Center, Orange Coast Medical Center in Fountain Valley, Calif., tells SELF.

The American Cancer Society also recommends that women talk to their doctors about additional testing. “At this time, experts do not agree what other tests, if any, women with dense breasts should get in addition to mammograms,” the organization says on its website. Research has shown that while ultrasounds and MRIs can help find some breast cancers that can’t be seen on mammograms, they can also result in false positive findings. As a result, a patient may undergo unnecessary biopsies and tests. The U.S. Preventative Services Task Force states that current evidence is “insufficient” to determine whether the potential benefits of an ultrasound, MRI, or digital breast tomosynthesis (a test that takes images from different angles of a woman’s breast) outweigh the harms (such as false-positives).

Posted 12/8/17

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References

SELF. Why Women With Dense Breasts May Need More Than Just a Mammogram.

People. Jill Goodacre’s Cancer Was Undetected on a Mammogram Because of Dense Breasts: Here's What That Means.

Dense-Breast.info: Guide to State Breast Density Laws

American Cancer Society. Breast Density and Your Mammogram Report.

Karla Kerlikowske, MD; Weiwei Zhu, et. al. Identifying Women With Dense Breasts at High Risk for Interval Cancer: A Cohort Study. Annals of Internal Medicine. 2015;162(10):673-681.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.