I always had very lumpy breasts. Back in 1999 my doctor reassured me that this is not a risk factor for breast cancer. But, our knowledge has changed dramatically since and according to Cancer Care Ontario, the Ontario government’s principal adviser on cancer, breast density is one of the strongest risk factors for breast cancer, as strong as family history.
What is breast density? Breast tissue is composed of milk glands, milk ducts and supportive tissue (dense breast tissue), and fatty tissue surrounding them (nondense breast tissue). On a mammogram, nondense breast tissue appears dark and transparent. Dense breast tissue appears as a solid white area, same as cancer lumps and this makes it difficult to detect the cancer. To top it off, having dense breasts increases breast cancer risk.
About half of women undergoing mammograms have dense breasts. Younger or slim women or women taking hormones after menopause are more likely to have dense breasts. After the mammogram, patients will receive a report which will notify them only if the tissue in their breasts is 75% or more fibroglandular rather than fatty. These women are having a mammogram every year, as opposed to the screening program’s standard of every two years. But if density is below 75% but still high enough to raise a concern, women are not informed.
Dense Breasts Canada, a group of breast cancer survivors and health-care workers dedicated to raising awareness about breast density, is fighting for mandatory notification of breast density across the country, to both patients and their doctors. This now varies by Province. They are also pushing for a breast ultrasound for patients whose breasts are greater than 75 per cent fibroglandular tissue. Currently, this additional test, which is less susceptible to breast density’s masking effects, is not part of the provincial screening program. Instead, patients with >75% are having mammograms every year, rather than the standard two years.
Radiologist Paula Gordon, a University of British Columbia clinical professor and medical adviser to Dense Breasts Canada, said that women should be notified of this risk factor. Knowing the level of their breast density may prompt women to take better care of themselves, conduct self-exams more regularly, perhaps watch their weight and exercise, which could mitigate an increased risk of developing breast cancer.
Dr. Martin Yaffe, a University of Toronto professor and cancer researcher at Sunnybrook Health Sciences Centre who has been studying breast density for 25 years and helped develop Ontario’s breast screening guidelines, said the province should develop guidelines for supplementary screening, including testing with ultrasound or MRI. He said that since mammograms tend to be less accurate at detecting cancers in women with dense breasts, doing them more frequently is not the answer. Yaffe suspects that the cost of supplementary screening may have something to do with the province’s reluctance to make additional testing part of the protocol. Right now, the only way for a patient to have additional screening is for them to “push” for it, he said.
A new method coming from Japan is using radiofrequency waves and is capable of clearly detecting tumours. It does not require compression of the breast and is free from radiation exposure. It will be available in a few years.
Leda Raptis, September 2018
Her dense breast tissue hid cancer for years. Now she’s warning others
Fibrous breast tissue can obscure or camouflage cancer in mammograms
CBC Radio · September 14
Written by Jonathan Ore. Produced by Jeff Goodes.
In 2014, Michelle Di Tomaso was diagnosed with advanced breast cancer. It came as a shock to her because she had undergone four clear mammograms.
She was devastated to learn that the tumour in her left breast had been growing for two to three years.
She believes she might have caught it earlier if she knew one thing: she has dense breasts.
But Di Tomaso didn’t discover that until after undergoing an ultrasound and a biopsy.
“It was a camouflage effect, and they missed it. I said, ‘They missed it for three f–king years?’ And [the medical oncologist]’s like, ‘It happens,'” Di Tomaso recalled to White Coat, Black Art‘s Dr. Brian Goldman.
Following the discovery, she underwent rounds of chemotherapy and radiation, a double mastectomy and a raft of complications.
Breast density has been known in the medical community for decades, but it’s still a relatively unknown issue to family doctors and patients, in part because physicians aren’t instructed to tell their patients about it.
While fatty tissue appears as dark grey in a mammogram, dense tissue shows up as mostly white — just like cancers.
- Telling women they have dense breasts could save lives, says cancer survivor
- How one group’s fight for ‘just a line’ on a mammogram report could save lives
In 2016, Di Tomaso co-founded Dense Breasts Canada, a non-profit group which raises awareness about breast density and lobbies to make it easier for patients to find out if they have dense breasts.
“I want a woman to be told her breast density when she has a mammogram … If that woman has dense breasts, I want her to have an ultrasound,” she said.
Nearly half of U.S. women have dense breast tissue
Despite the name, dense breasts don’t feel any different to the touch. Only a mammogram can identify whether someone’s breast tissue is denser than average.
Over 40 per cent of women, aged 40 to 74, have some degree of dense breast tissue, according to a 2014 U.S. study.
It’s like somebody having high blood pressure and not telling them. No family doctor would do that.– Dr. Paula Gordon
Dr. Paula Gordon, Dense Breasts Canada’s medical adviser, says she often sees women with dense breasts who have had their cancer missed by a mammogram.
“This is where the anger comes from,” she said. “They were never told they had dense tissue, and so they didn’t realize there was this huge difference in the sensitivity of mammography depending on how dense the breast tissue is.”
Gordon, who is the medical director of the Sadie Diamond Breast Program at B.C. Women’s Hospital, added that cancer is “four to six times more common” in women with the highest breast tissue density, but researchers don’t know why.
In 1986, the BC Cancer Agency became the first provincial agency to do screening mammograms. From the very beginning, radiologists were asked to indicate on each mammogram if the woman had dense breasts and so they did.
But there wasn’t a directive to tell patients.
“It’s like somebody having high blood pressure and not telling them. No family doctor would do that,” Gordon said.
“When I raised it at a committee and said, ‘Why aren’t we telling them?’ they said, ‘We don’t want to make women anxious.'”
I will take that little bit of anxiety to find out it’s OK, than not knowing and then being told I have cancer.– Michelle Di Tomaso
Di Tomaso was “very insulted” when she first heard that reasoning.
“I will take that little bit of anxiety to find out it’s OK, than not knowing and then being told I have cancer — just because you guys don’t want to tell us. Because of ‘anxiety.'”
Gordon wants women to start going for mammograms closer to the age of 40, which she calls “the ideal age to start screening.”
That way women can find out sooner whether they have dense breasts. If they do, they can be screened with an alternative method, such as an ultrasound or MRI to check for potential cancers.
Currently, the Canadian Task Force on Preventive Health Care recommends women have a mammogram every two years starting at age 50.
Updating guidelines for patients
Quebec is the only province that requires a woman’s breast density information be given to her family doctor.
In other provinces, doctors might be given the info from a mammogram report, but they aren’t required to inform patients.
In New Brunswick, where an election campaign is currently underway, both Liberal and Progressive Conservative leaders pledged to ensure women are notified of their breast density.
The discussion there has been spearheaded by breast cancer survivor Kathy Kaufield, who has been promoting breast density awareness with her #TellMe social media campaign.
In Prince Edward Island, Health PEI is planning to look at how and when patients are given breast density information as part of an upcoming review of their breast cancer screening program.
Meanwhile, in the U.S., more than 30 states require doctors to tell women their breast density.
‘I just want women to know’
Di Tomaso is encouraged by these small signs of change in Canada.
To her, it may begin with a simple line of text on a mammogram report, but it can make the difference between life or death.
“I just want women to know. I just didn’t want it to happen to anybody else,” she said.
What every Woman Should Know
Breast Density is seldom discussed by doctors with their female patients -yet it is one of the most important risk factors associated with the likelihood of developing breast cancer. Women with dense breasts are 6 times more likely to get breast cancer than women with less dense breasts. Dense breasts can also mask tumours in mammograms.
The attached article, reprinted from the Toronto Star, provides important information that every woman should know about breast density.
Read article – Breast Density – What Every Woman Should Know
or Download Article – Breast Density - What Every Woman Should Know
I Wish Someone Had Told Me
Dense Breasts Canada
JUN 20, 2018
We’re super excited to share our video with you and we are really grateful to the women who so graciously and eloquently talk about their breast cancer experiences. 5 women, 5 stories. No one told them their breast density or the implications. Please watch and also share this link with all the women who are important to you youtube.com/watch?v=Zb5LEBsovAM&feature=youtu.be
New from Japan
Researchers in Japan have developed a new way to detect breast cancer
By The Japan News
Mon., May 21, 2018
KOBE, JAPAN—A group led by Kobe University has developed a new image inspection method to detect breast cancer with high accuracy by using a transmitter that sends weak radio signals when placed over the breast.
The method provides clear three-dimensional images without inflicting pain on patients, unlike mammograms that are currently used for breast cancer screenings, according to the group. The group aims to start clinical trials in fiscal 2019 in a bid to spread the new technique in screenings.
Kobe University professor Kenjiro Kimura, a specialist in metrology, and other researchers looked at the fact that breasts are mostly made of fat, with radio waves deflecting body tissue but penetrating fat.
The group established the method of instantly creating a stereoscopic image of cancerous tumours by transmitting radio waves to a breast and analyzing the waves that were deflected off tumours.
In mammograms, patients often feel pain because their breasts are compressed between plates. Moreover, in the case of women with dense breast tissue, the overall image is whitish, making it difficult to detect abnormal areas, which also appear as white.
The new method is painless and, most importantly, is capable of clearly detecting tumours. It is also free from radiation exposure, and the radio wave energy involved is no more than 0.1 per cent of the radio waves transmitted from mobile phones.
The group looked into the accuracy of the new method by testing about 200 people, including cancer patients with dense breast tissue. The results matched with over 90 per cent of the results of other types of examinations such as mammograms, ultrasonographic scans and biopsies. The group was also able to detect early-stage cancer, which is difficult to detect using standard methods.
“I hope to commercialize this method through medical equipment by around 2021 by getting co-operation from major manufacturers,” Kimura said.
Mitsuhiro Tozaki, head of the radiology department of Sagara Hospital’s Breast Centre in Kagoshima, said: “Women with dense breast tissue account for about 80 per cent of all women, so it is vital to develop an examination method to replace mammograms. The method may be applied to other medical uses such as examining the effectiveness of drug treatments.”