Do You Have Dense Breasts? You May Need a Supplemental Breast Cancer Screening

About 40 percent of women and people assigned female at birth (AFAB) have dense breasts, something that not only increases your risk of developing breast cancer but also reduces the effectiveness of mammography—the traditional breast cancer screening.

That’s a pretty significant number considering the 242,000 cases of breast cancer diagnosed in the United States every year.

New guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend beginning breast cancer screenings at age 40 and continuing every other year. However, if you have dense breasts, you may need more than the traditional mammogram.

Learn more about the importance of specialized screenings and tailored support for individuals with dense breast tissue.

Dense breasts: Increased risk and screening challenges

Individuals with dense breasts have a greater risk of developing breast cancer. “We’re not exactly sure of the mechanism,” explained Nandini Kulkarni, M.D., medical director of surgical oncology at Inspira Health. “However, we know that cancers often develop in glandular tissue, and the more glandular tissue you have, the greater your risk. So the more dense breast tissue you have, the higher your risk of breast cancer.”

Breast density is usually determined during a person’s first mammogram and is categorized into four levels: almost entirely fatty, scattered areas of fibroglandular density, heterogeneously dense and extremely dense. Heterogeneously dense and extremely dense breasts are considered dense—but having some fibroglandular tissue is normal and not necessarily concerning. The higher levels of density indicate more fibrous and glandular tissue compared to fatty tissue, which can make it harder to detect abnormalities.

The size or shape of your breasts do not determine density—it can only be detected through a mammogram. While all breast cancer screenings must start with a mammogram, people with dense breasts usually need a supplemental imaging test to properly screen for cancer.

“Dense tissue appears white on mammograms—the same color as potential tumors,” said Dr. Kulkarni. “This similarity in appearance can obscure small masses or lumps and make it difficult to distinguish between normal dense tissue and potential cancerous growths.”

Factors that can affect breast density

Several factors can influence breast density, including:
 

• Age: Breast density typically decreases with age, especially after menopause. Younger people often have denser breast tissue.
• Hormonal factors: Higher levels of estrogen and progesterone, such as during hormone replacement therapy (HRT), pregnancy or from birth control pills, can increase breast density.
• Genetics: If you have a family history of dense breasts, you're more likely to have dense breast tissue as well.
• Body mass index (BMI): People with a lower BMI are more likely to have dense breasts due to having less fatty tissue.
• Menopause: Hormonal changes post-menopause can reduce breast density.
• Breastfeeding: While breastfeeding can temporarily affect breast density, density generally returns to pre-pregnancy levels after breastfeeding stops.
• Medications: Hormonal treatments and certain medications, including those related to cancer therapies, can also affect breast tissue density. Understanding the factors that influence breast density can help you and your OB/GYN make more informed decisions about your breast cancer screenings and overall breast health.

New mammography guidelines for dense breasts

Recent updates to the Mammography Quality Standards Act (MQSA) now require that all mammography reports include information about breast density. Patients will now receive a clearer breast tissue assessment, along with an explanation of how dense tissue can affect mammogram accuracy and breast cancer risk. These updates help standardize how breast density information is communicated, ensuring patients receive consistent guidance.

The importance of specialized breast cancer screenings

While mammography is the recommended standard for initial screening for breast cancer, adding a supplemental screening can help identify cancers not found through a traditional mammogram.

“Your physician may recommend additional imaging tests such as ultrasound or MRI,” said Dr. Kulkarni. “Ultrasound screenings can help differentiate between solid masses and cysts, while MRIs offer a more detailed view of the breast tissue without being affected by its density.”

Here are three types of supplemental screenings for dense breasts:
 

• Breast magnetic resonance imaging (MRI): Breast MRI uses magnetic fields to produce detailed images, ideal for high-risk individuals and those with dense breasts. It offers excellent resolution but is costly and may result in higher false positive rates.
• Handheld ultrasound: This method involves a technician using a handheld device to scan the breasts, primarily to examine specific areas after a mammogram. It distinguishes between solid and cystic masses but varies in quality based on the operator's skill.
• Automated breast ultrasound (ABUS):  ABUS uses an automated scanner to create 3D images of the entire breast, reducing variability seen in handheld ultrasounds. However, any findings seen on an ABUS exam will require the patient to return for a handheld ultrasound.

Proactive measures for early detection

Understanding the complexities of dense breast tissue is essential for effective screening and early detection. Regular breast self-exams can help you notice changes that might require a professional's assessment.

"Understanding your family history and discussing your risks with your physician is the best way to determine an effective screening approach," said Dr. Kulkarni. "Also, consider lifestyle changes like eating a balanced diet, exercising regularly and reducing alcohol intake to lower your breast cancer risk."

Staying informed and proactive allows you to manage your breast health confidently and accurately. With the new regulations in place, you’ll be better equipped to understand your breast density and make informed decisions about your screenings.

Detect breast abnormalities before symptoms appear. Schedule your mammogram today.