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The results of Nancy Cappello's mammogram returned to normal in 2003. She was shocked when, six weeks later, her doctor found a ridge under her right breast. She had stage 3 advanced breast cancer that had spread to the lymph nodes and her mammogram had missed it.
Cappello later discovered that she, with 40 to 50% of American women over 40, had dense breasts. This is a classification that can increase the risk of breast cancer (as confirmed by a recently published study in the journal Radiology). increase the chances that a mammogram does not detect it. Dense breasts have more fibrous or glandular tissue and less fat than other breasts.
To help others and spread the word, Cappello launched a campaign to get a new Connecticut law passed in 2009, requiring health care providers to inform women if a mammogram reveals that their breasts are dense . About 35 states have similar laws, and about six others, along with the federal government, are considering adopting similar legislation.
This is generally good news, but such laws can also be confusing as many women and even doctors do not know how to proceed.
"I'm everything for women who have information, but there is no evidence to support what to do," says Karla Kerlikowske, primary care physician and professor of medicine, epidemiology and biostatistics at the University of California at San Francisco .
Here's what you need to know.
Extra cells, extra tissue
In itself, having dense breasts is only a moderate risk factor for breast cancer. Although nearly half of women who undergo mammograms have dense breasts, only about a quarter of those in this group have an increased risk of developing cancer that will not be detected by mammography, says Kerlikowske.
Yet, the risk is there.
The new radiology study, for example, found that of approximately 108,000 women aged 70 to 69 who had been screened for breast cancer between 2007 and 2015, those with dense breasts were 1.37 times more likely to have breast cancer. Have breast cancer than those with non-dense breasts.
Women with dense breasts were also nearly three times more likely than women with non-dense breasts to have an aggressive form of cancer.
The authors of the study, however, noted that the absolute risk of breast cancer in these women was still low: only 5 out of 1,000 women with low-density breasts had cancer and 13 out of 1,000 women with dense breasts had cancer. cancer.
Dense breasts contain many more cells, connective tissue and collagen than less dense or oily breasts. More cells mean more chances for any of them to get corrupt.
Dense breast tissue can also mask cancerous lesions on a mammogram, increasing the chance that a cancer will not be detected. This extra tissue has the same shade of white as the lesions or tumors on an x-ray, making mammography on dense breasts only effective at 62-68%. This represents a considerable advantage over the effectiveness of 85% in women with oily breasts.
One of the problems with the new laws, says Kerlikowske, is that they do not tell you the magnitude of the density, only that women have dense breasts. The degree of density is important. The denser your breasts are, the higher your risk.
"It's like saying," I'm warning you that you're big, "says Diana Buist, Senior Research Scientist at the Consortium for Breast Cancer Surveillance and Director of Research and Strategic Partnerships at the Institute for Research on Cancer. Washington Kaiser Permanente health in Seattle. .
It's a hallmark of your physiology, she says, but it's unclear how it could increase your risk of cancer and what you can do to cope with this risk.
What you should do
Some states recommend that women with dense breasts continue with additional imaging, such as breast ultrasound or magnetic resonance imaging (MRI). But even then, says Kerlikowske, it's unclear whether the additional imaging is effective at detecting cancers that are not identified on a mammogram.
Ultrasound and MRI can also be expensive and time consuming, says Kerlikowske.
The more imaging tests there are, the more chances there is a false positive or that we find a problem of no clinical significance. This could possibly subject a woman to invasive and unnecessary procedures such as a breast biopsy, not to mention her anxiety and worries.
So what should you do if you have dense breasts?
First, do not panic. Dense breasts alone are not enough to significantly increase your chances of developing cancer, says Kerlikowske. The most important thing is to ask if your doctor can identify the degree of density and then assess your overall risk of breast cancer using online tools such as the risk calculator of the Breast Cancer Surveillance Consortium.
If you have dense breasts and other risk factors, such as a family history of breast cancer, the use of complementary imaging, such as an ultrasound or MRI in addition to mammography, may be a good option.
"There is no clear strategy," says Buist. "Be aware of your risks and understand where you are in the spectrum."
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