Breast Cancer Awareness Month is a timely reminder to get checked and to know the signs and symptoms.

What are dense breasts?

Breast density refers to breasts that have a high proportion of dense tissue as compared to fatty tissue. This is detected in a mammogram – dense tissue shows up as white shapes on the image, whereas fatty tissue shows a clear image.

Roughly half of all women have dense breasts, so it’s a very common issue and that does not mean that cancer is a concern.

There are four categories of breast density that a radiologist uses when analyzing a mammogram. Categories C and D are considered to be dense breasts:

1. Class A (or 1): Fatty
2. Class B (or 2): Scattered fibroglandular density
3. Class C (or 3): Heterogeneously dense
4. Class D (or 4): Extremely dense.

Are dense breasts a concern?

When a mammogram reveals dense breasts, patients do not need to be alarmed. The popular concern with dense breasts is that it is more difficult to get an accurate picture via mammography, meaning that it’s possible to miss a cancerous growth.

Secondly, dense breasts are considered to carry a greater risk of breast cancer than average. This means that additional screening is usually recommended for dense breasts, such as an MRI, MBI, or ultrasound.

For some women, this may mean it is appropriate to have annual screenings earlier than the guidelines otherwise suggest (from age 45 upwards).

Do physicians have to inform patients of their dense breasts?

38 states now require some form of notification to go to patients who have dense breasts. The type and level of notification varies, with some providers sending a letter that notifies the patients, while others go beyond by requiring an explanation and potentially some recommended actions.

This wide variation in how breast density is dealt with has been met with confusion and anxiety among patients. For many, getting a notification with no explanation leaves them questioning whether something is wrong.

There is no standard from state to state, but there are best practices that would be better for physicians to follow, regardless of minimum requirements. Patients should be informed of breast density definitions and offered options for further screening.

What are the known risk-factors for breast cancer?

With ongoing research, there are known risk factors for breast cancer. Here are a few:

• Being overweight, especially after menopause. Fatty tissue is the main source of estrogen after menopause and higher fat composition means higher levels of estrogen.
• Diet. There is ongoing research into links between diet and breast cancer risk. Current recommendations include eating plenty of fruits and vegetables, limiting consumption of saturated fat and processed meats, and eating foods high in omega-3 fatty acids.
• Not getting enough exercise. This is a known risk factor for a few different cancers. The current American Cancer Society guidelines suggest 45 to 60 minutes of exercise, five or more days per week.
• Smoking. This has shown to create an elevated risk for breast cancer.
• Exposure to estrogen. Estrogen exposure can come from hormone replacement therapy (HRT), alcohol consumption, being overweight, starting menstruation before the age of 12, going through menopause after age 55, environmental exposure to estrogen (such as in meat), or pesticides that produce an estrogen-like response when broken down by the body.
• Recent oral contraceptive use. The risk is decreased in women who last took an oral contraceptive more than ten years ago.
• Age. From ages 30 to 39, the risk is 1 in 228, or .44%. That jumps to 1 in 29, or just under 3.5% by ages 60 and above.
• Family history. If you have first-degree relatives or multiple relatives diagnosed with breast or ovarian cancer (especially before the age of 50), then your risk is higher. However, if you have no family history, you still can’t be complacent. Around 80% of women diagnosed with breast cancer have no family history.
• Personal history. This puts you at risk of developing breast cancer again.
• Radiation to the chest as a child. This has been shown to increase breast cancer risk, especially if the treatment was while the breasts were still developing.

What are the recommendations for screening?

Here’s what the American Cancer Society currently recommends:

• Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
• Women ages 45 to 54 should get mammograms annually.
• Women 55 and older should switch to mammograms every two years or can continue yearly screening.
• Screenings should continue as long as a woman is in good health and is expected to live 10 more years or longer.
• All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening.

Mammograms are the typical choice for screening but there are a few other options, especially if breast density or other factors call for them.

Self-awareness is a highly recommended action for early detection of breast cancer. This means knowing your own breasts, their regular size and shape, how they change during monthly hormonal processes, and how they feel. Anything unusual should warrant a visit to your physician because many breast cancers are first detected through self-examination.

What are the symptoms of breast cancer?

There are different types of breast cancers, each with varying symptoms. Sometimes there are no symptoms at all and cancer is detected through routine screening. Here are some symptoms that should be known:

• A lump or mass on the breast(s). This is the most commonly-known symptom.
• Skin changes on one or both breasts. For example, swelling, redness or other visible differences.
• Increase or change in size and shape of the breast(s).
• Pain in the breast(s).
• Discharge from the nipple(s).
• Change in appearance of the nipple(s).
• Pitting of the breast(s) skin (appearance similar the surface of an orange peel).
• Peeling or flaking of nipple(s) skin.
• Change in breast(s) color.
• Itchy or irritated breast(s).

It’s important to note that other, benign conditions could also be behind any of these symptoms, but it’s always better to get checked out.

Awareness is Key

Breast cancer is diagnosed in roughly one in eight American women during their lifetime. This means that most people will be affected either directly or indirectly by breast cancer at some point in their lifetime.

While some risk factors cannot be helped, there are others that can be prevented, such as diet, exercise, and maintaining a healthy body weight. All women should be familiar with their own breasts as early detection is critical for the chances of survival.