Dense Breasts Raise Cancer Risk

[tousled1]

I found this article interesting and thought I'd pass it along.



Dense Breasts Raise Cancer Risk
Two studies found it was as important a predictor as age By Amanda Gardner
HealthDay Reporter



WEDNESDAY, Sept. 7 (HealthDay News) -- Two new studies suggest breast density is nearly as important as age in predicting who is going to develop breast cancer.

The information may help better identify women at high risk for the disease, the researchers noted.

"After age, it's probably the most important factor," said William E. Barlow, lead author of one of the studies and a senior investigator at Group Health Cooperative in Seattle. "If we wanted to identify women who were really at high risk for chemoprevention efforts or more intense screening surveillance, then any model that incorporates breast density is going to be better at picking out those women."

Both studies are in the Sept. 6 issue of the Journal of the National Cancer Institute.

Since the late 1980s, medical professionals have relied on the Gail model to assess breast cancer risk in women undergoing annual mammography. That model uses risk factors known at the time, such as current age, age at first menstrual period, age at birth of first child, number of first-degree relatives with a family history of breast cancer and number of previous breast biopsies. More recently, race and atypical hyperplasia were added to the model.

Experts had speculated that adding newly identified risk factors for breast cancer such as breast density and use of hormone therapy might improve the test's predictive powers.

Barlow and his colleagues looked at 11,638 women who had developed breast cancer, out of a larger group of about 1 million.

Among premenopausal women, age, breast density, family history of breast cancer and a previous breast procedure were significant risk factors for developing breast cancer. Having any type of prior breast procedure was associated with about a 50 percent increased risk. Women with extremely dense breasts had about a fourfold greater risk than women whose breasts were not dense.

For postmenopausal women, factors included age, breast density, race, ethnicity, family history of breast cancer, a prior breast procedure, body-mass index, natural menopause, hormone therapy and a prior false-positive mammogram.

The model may perform better than the Gail model, although the accuracy was far from perfect. This suggests that the major determinants of breast cancer are still unknown.

A second study, conducted at the National Cancer Institute, used an updated version of the Gail model to assess the absolute risk of developing breast cancer. This model also included breast density, along with weight, age at first live birth, number of previous benign biopsies and number of first-degree relatives with breast cancer.

Again, this model predicted that women with high breast density had an increased risk of breast cancer.

It's unclear if breast density can be considered a modifiable risk factor.

"It may be modifiable, but we don't know that for sure," Barlow said. "It is related to hormone use in women. Their breasts can be denser during the time they're on hormone replacement therapy."

It's also not clear exactly how this new information will be incorporated into practice. Breast density generally needs to be measured by a radiologist. "It's not something that a woman can judge for herself," Barlow explained. "There really isn't a feedback mechanism from the radiologist back to the woman to say what the breast density is."

In the future, however, Barlow envisions mammography facilities becoming more like risk-counseling facilities that incorporate breast density along with other risk factors and past mammogram results. "But that would require an evolution of mammography centers," he noted.

Even in the more immediate present, the findings reinforce the notion of taking steps to prevent breast cancer in high-risk and other women.

"We as a medical community still have not accepted the paradigm that we can identify women who are at a high risk for developing breast cancer," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "We could intervene with a treatment to reduce their risk."

"We don't use the tools we already have to identify women at a high risk for breast cancer and offer them potential treatment to reduce their risk like we do for cholesterol and heart disease," he continued. "Now, we're further defining the model that will predict even better who could potentially benefit from these tools."

[Hopeful]

Thanks for posting this. I would certianly echo the sentiment that mammography centers should include a counseling aspect. My cancer was detected at my annual mammogram (I have been conscientious about screening all my life: baseline mammo at 35, bi-annual mammos from 40 to 50 and annuals from 50 to today), and it wasn't until I was diagnosed and requested copies of all of my prior reports (not just the "no evidence of disease" letters that they send to the patients) that I learned I have extremely dense breasts. Had the radiologist (or my gyn, who ordered the studies evey year) mentioned it at least once in all that time, I would certainly have made the effort to be extra vigiliant, (i.e., finding a place that does digital mammos) and might have caught this at an even earlier stage.


Hopeful

[RhondaH]

I've done some reading and have come up limited, but does anyone know what causes or how to prevent dense breast as I TOO have this problem. Thank you. Take care and God bless.

Rhonda

[tousled1]

I posted the above article because I too have dense breasts. I was fortunate that I had all copies of my mammogram reports and each and everyone of them said I had dense breasts. I was also diligent about getting my mammos done every year -- matter of fact about every other year I would have a "dignostic" mammo. I had previously had lumps (that I found myself) removed in 1970 and 1981 - one from each breast - that were benign. Unfortuantely, I found a lump that was cancer last Oct. I took all my previous mammo films and reports to my first viisit with oncologist and she couldn't believe that nothing showed up on previous mammos. I think I have lost my faith in mammos. Good thing I won't have to have anymore.

[Hopeful]

RondaH,

Here are two links with some information. The first http://www.breastcancer.org/research...cs_091902.html concludes, "Genes you inherit from your parents probably have a bigger influence on the density of breast tissue, as determined by mammography, than any other single factor."

The second http://cebp.aacrjournals.org/cgi/con...stract/9/2/151 is to an abstract of a fascinating article (which can be linked from the abstract) titled, "Association of Diet and Mammographic Breast Density in the Minnesota Breast Cancer Family Cohort." The study concluded, "There was a suggestive positive trend between breast density and daily alcohol consumption in both premenopausal and postmenopausal women. After adjustment for other sources of alcohol, only wine intake among postmenopausal women was significant such that white wine showed a positive association and red wine an inverse association with percent breast density. There was no association with other examined dietary factors."

Kate,

I recall reading a quote from a radiologist that reading the mammograms of dense breasted women was like "peering through a snowstorm." It did not give me comfort.

Hopeful

[tousled1]

Hopeful,

Reading your reply sure did bring a smile to my face. I'll think of every time I see snow.

[AlaskaAngel]

HER2+++ cancers are fast-growing. Again -- 2004 article, MRI vs mammo:

NEW YORK (Reuters Health) - Magnetic resonance imaging (MRI) is "significantly more sensitive" than mammography in detecting multiple malignant foci in fibroglandular or dense breasts but not in fatty breasts, according to findings from The Italian Trial for Breast MRI in Multifocal/Multicentric Cancer published in the October issue of the American Journal of Roentgenology.

Dr. Francesco Sardanelli from the Istituto Policlinico San Donato in Milan and colleagues compared the sensitivity of MRI versus mammography for detecting additional malignant lesions in 90 women with breast cancer scheduled to undergo mastectomy (9 bilateral, 99 breasts).

Additional malignant lesions were detected more often by MRI than by mammography (152 vs 124). Pathologic examination of the whole excised breast -- the gold standard -- detected 188 additional malignancies.

According to Dr. Sardanelli, the malignancies that were missed by mammography were "significantly larger and more aggressive (70% were invasive cancers) overall than the malignant areas that were missed by MR."

MRI was most useful in women with dense breast tissue. In fibroglandular or dense breasts, the sensitivity was 81% for MRI versus 60% for mammography.

However, false-positive results remain a problem for both techniques, which have a "relatively low" positive predictive value, the authors report. The overall positive predictive value of 68% for MRI was not significantly different from the positive predictive value of 76% for mammography.

Previous studies have shown that up to 42% of women diagnosed with breast cancer in one breast have at least one other malignant lesion in the same breast. It's important to identify these other malignant areas to determine the best course of treatment, the authors note.

Based on the current findings, Dr. Sardanelli and colleagues believe that it would be worthwhile to perform a "dynamic MRI examination before treatment planning in patients with a nonfatty breast pattern."

The findings of the current study support those of several previous studies showing that MRI is more sensitive than mammography in the detection of breast cancer. (see Reuters Health reports September 15 and July 28, 2004, among others).

Am J Roentgenol 2004;183:1149-1157





IMHO



In my opinion, anytime a rads doc describes the breasts as being especially dense, if there are other risk factors such as family history, or nulliparity, etc. the patient should be entitled automatically to at least a bilateral full sonogram of both entire breasts, whether or not there are calcifications, if the doc or the facility or the insurance is unwilling to provide an MRI.

I also think we should also automatically receive a printed copy of the actual mammogram report within 2 weeks of the exam.

AlaskaAngel

[karen raines hunt]

I too had dense breasts. I had a mammogram in Oct 04 that was read as normal. In Jan 05, I found the lump, saw my gyn 2 days later. He thought it was just "fibrocystic changes," but did send me for an ultrasound which was read as normal. He told me not to worry and to come back in 2 months. I took his advice and 2 months later the malignant tumor was 12 cm. All along radiologists had been reporting that my breasts were extremely dense, but no one ever told me or suggested that I go for any other type of screening. I should have been having MRIs because of the extremely dense tissue. I had bilateral mastectomies...............the right side was prophylactic since the screening tools were not useful.

[SusanV]

I too have dense breasts. I questioned the surgeon about this, and he told me that you are born with the type of breast tissue that you have. If you have desnse breasts today, they are the genetic breasts that you were born with.


Not sure if this helps, just wanted to pass along the info that I was told.

[StephN]

This is an interesting thread and expands on this subject as we have discussed in the past.
I always got those letters after my mammos saying that they were "normal" but due to density of my breast tissue I should perform regular self checks. So, I was warned and doing when I found my lump, again only 3 months after the so-called "normal" mammogram result. Was about one year post-meno then.
Was told by my surgeon that the tumor was basically the same density as my breast tissue and that is why it was missed.

All the women (6) in my immediate family have dense breasts. None of us have ever taken hormal therapy. Tissue density is in our genes.

The post with the wine connection is curious to me as I am married to a Frenchman and we have wine with dinner every night, mostly red. That study makes NO sense to me at all. And remember that red wines (particularaly from Bordeaux) have high amounts of resveratrol, a cancer fighting agent.