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Dense Breasts? Get Smart About Cancer Screening


My daughter and I right after I was diagnosed in August 2013.

As a healthcare professional specializing in cancer, I was always good about staying on top of my regular mammograms.


April 2013 was no different. I went in for my mammogram screening and left with a clean bill of health. Just four months later, in August, I was diagnosed with stage IV breast cancer.


For decades, the mammogram – or an x-ray of the breast ­– has been accepted as the gold standard for breast cancer screening. The CDC currently recommends that women between the ages of 50 - 74 years old with average breast cancer risk get a mammogram every two years.


So, how could a mammogram have missed cancer that was waiting just below the surface?



Why a Mammogram Might Not Be Enough


While the mammogram is a proven screening tool that is often able to detect cancer years before it can be felt, it is not enough for some women – specifically, those with dense breasts.


Breasts are comprised of lobules – or glandular tissue ­– which produce milk, and ducts, which transport the milk from the lobules to the nipple. The lobules and ducts are held into place and shaped by fibrous tissue and fat.


Simply, dense breasts have a higher proportion of fibrous or glandular tissue and a lower proportion of fat than average. There are four commonly accepted degrees of denseness:


1. Fatty (considered the average)

2. Scattered or moderately dense

3. Heterogeneously or mostly dense

4. Extremely dense


About 50% of all women have at least moderately dense breasts, with 10% of these women falling into the extremely dense category.


How Do I Know If I Have Dense Breasts?


Given the significant percentage of women with dense breasts, there has been a surprising lack of public awareness or education around this topic, even amidst the growing prominence of Breast Cancer Awareness Month.


Many women, like myself, don’t realize they have dense breasts until something goes wrong. This is in part because there’s no observable way to tell if you have dense breasts. Breast shape, size, or firmness have no correlation to the amount of fibrous or glandular tissue.


The only way to determine if you have dense breasts is through mammogram screening. That’s why getting regular mammogram screenings, even if you have extremely dense breasts, is essential to your wellness. It’s just not the end-all-be-all of cancer screening; on average, mammograms alone fail to detect the presence of cancer in about 40% of cases involving women with dense breasts.


Breast Cancer Screening Recommendations


Dense-breasted women are considered at moderate risk for breast cancer. Women with extremely dense breasts are about 2x more likely to develop cancer than those with fatty breasts, while those with mostly dense breasts are at 1.2x greater risk.


Like women with average amounts of fatty tissue, those with dense breasts should start with a mammogram and have their doctor determine the level of density to understand risk factor and implement the best prevention strategy moving forward. The good news is that most states now have laws that require doctors to disclose breast density on mammogram results to help raise awareness and provide women with the most effective screening for their body types. Georgia has one such law: Margie’s Law.


If you are one of the many women with dense breasts, you and your doctor will work together to determine the best screening options and schedule. Regular MRI screening has been determined to be a cost-effective and highly successful way to detect cancer early.


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When it comes to having dense breasts, just like any other risk factor, awareness is key. After I was diagnosed with breast cancer, my surgeon told me she could see signs of my cancer developing over the previous four years of mammograms. If I had known I had dense breasts, my doctors and I might have looked at my results differently and been able to spot my cancer before it got to stage IV.


I’m grateful I’m here to tell my story and raise awareness among other women about how to protect themselves. By understanding your body, you can make informed choices that will give you the best chance of catching cancer early and treating it quickly. And if you need any extra support determining the best screening or treatment options, a patient advocate is always available to walk alongside you every step of the way.

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