What are dense breasts?
Breasts are the same in men and women, until puberty. During sexual maturity, a woman’s breast tissue grows in size and amount.
Women’s breasts consist of mammary glands, or the glandular tissue, that hold milk-producing cells. They also have connective tissue, which includes adipose, or fatty tissue. These tissues make up the shape of your breasts.
Your breasts won’t necessarily feel different if they’re dense. The only way to know if you have dense breasts is through a diagnostic mammogram, a type of X-ray. The mammogram will show what kind of tissues are predominant in your breasts.
Dense breasts are linked to an increased risk for breast cancer. Studies show that women with extremely dense breast tissue are at risk for breast cancer four to six times more than women of the same age with the least amount of dense breast tissue.
Other risk factors for breast cancer include:
- female sex
- older age
- a family history of breast cancer
- race and ethnicity
If you or your family members have genes associated with breast cancer, such as the BRCA1 and BRCA2 genes, you may be considered at higher risk.
Read on to understand how dense breasts are diagnosed, and how it relates to your risk for breast cancer.
What is the structure of the breast?
Learning the structure of a breast can help with understanding breast density. The biological function of the breast is to make milk for breastfeeding.
The raised area on the outside is the nipple. Surrounding the nipple is darker colored skin called the areola.
Inside the breast is glandular, fatty, and connective tissue. A system of lymph nodes, called the internal mammary chain, runs through the center of the chest.
Glandular tissue consists of a complex network of structures designed to carry milk to the nipple.
This glandular part of the breast is divided into sections called lobes. Within each lobe are smaller bulbs, called lobules, which produce milk.
Milk travels through small ducts, which come together and connect into larger ducts designed to hold the milk. The ducts end at the nipple.
Connective tissue in the breast provides shape and support. Muscle tissue is present around the nipple and the ducts, which helps to squeeze milk toward and out of the nipple.
There are also nerves, blood vessels, and lymphatic vessels. Breast tissue extends from the breastbone near the middle of the chest all the way to your armpit area.
The lymph vessels of the breast drain excess fluid and plasma proteins into lymph nodes. Most of this drainage goes into nodes in the armpit. The rest goes to nodes located in the middle of the chest.
Fatty tissue is the remaining component of breast tissue. The more fatty tissue a breast has, the less dense it’s considered to be.
After menopause, breasts are typically composed more of fat than other connective and glandular tissue. This is because the number of lobules decreases and shrink in size after a woman goes through menopause.
What causes dense breasts?
Dense breasts are normal in many mammograms. According to Journal of the National Cancer Institute, nearly 40 percent of women in the United States have dense breasts. Factors that increase the likelihood of dense breasts are:
- middle age, especially your 40s and 50s
- higher birth weight
- higher body weight in adolescence and adulthood
- hormone therapy, especially for treatment of menopause symptoms
- having no children
- being premenopausal
Dense breasts can have a genetic component. Your chances of having dense breasts increase if your mother has them too.
Make an appointment with your doctor if you’re concerned about dense breasts and your risk for breast cancer.
How are dense breasts detected?
When radiologists look at your mammogram, breast tissue will show up as black and white. Glandular and dense connective tissue will show up white on a mammogram because X-rays don’t pass through as easily. This is why it’s called dense tissue.
X-rays pass through fatty tissue easier, show it shows up black and is considered less dense. You have dense breasts if your mammogram shows more white than black.
A classification system, known as the Breast Imaging Reporting and Database Systems (BI-RADS) Breast Composition Categories, recognizes four categories of breast composition:
|BI-RADS Composition Category||Breast tissue description||Ability to detect cancer|
|A: Mostly fatty||mostly fatty tissue, very few glandular and connective tissues||cancer will likely show on scans|
|B: Scattered density||mostly fatty tissue with few foci of connective and glandular tissue||cancer will likely show on scans|
|C: Consistent density||even amounts of fatty, connective, and glandular tissue throughout the breast||smaller cancer foci are difficult to see|
|D: Extremely dense||significant amount of connective and glandular tissue||cancer may blend in with tissue and be difficult to detect|
Ask your doctor about the BI-RADS results related to your breast tissue density when you get your mammogram results.
How do dense breasts affect your risk for cancer?
Increased risk for cancer
Dense breasts make mammograms harder to interpret. Some studies have shown that women with extremely dense breasts have a greater risk of developing breast cancer. Roughly four to six times more than women with mostly fatty breasts.
The cancer appears to develop in areas where the breast is dense. This suggests a causative relationship, but the exact connection is unknown.
Research also suggests that women with dense breasts have more ducts and lobes. This increases their risk because cancer often arises in these places. Researchers are still studying this concept.
Dense breasts don’t affect other outcomes such as survival rates or response to treatment. However, this study suggests that women with dense breasts, who are considered obese or have tumors of at least 2.0 cm, have a lower breast cancer survival rate.
Traditionally, doctors use mammography to diagnose potentially harmful lesions in the breasts. These lumps or lesions usually appear as white spots against black or grey areas.
But if you have dense breasts, that tissue will appear white as well. This makes it more difficult for doctors to see potential breast cancer.
According to the National Cancer Institute, about 20 percent of cancers are missed in a mammography. That percentage can approach 40 to 50 percent in women with dense breasts.
Studies have also found that digital and 3-D mammograms are better for detecting cancer in dense breasts because digital images are clearer. Fortunately these types of machines are becoming more common.
How you can prevent or lower
your risk for cancer
You can help reduce your risk for breast cancer by taking steps to live a healthy lifestyle. Examples include exercising regularly, refraining from smoking, and limiting alcohol intake. Women should typically consume no more than one serving of alcohol per day.
It’s also recommended to eat healthy. But know that diets won’t affect your breast density, according to a study in Cancer Epidemiology, Biomarkers & Prevention. The study found no link between breast density and:
- crude and dietary fiber
- total protein, including animal
Formulate a screening plan with your doctor
Many states, including California, Virginia, and New York, require radiologists to tell you if your breasts are extremely dense. While having dense breasts doesn’t necessarily mean you have breast cancer, knowing you have dense breasts is a step towards health awareness. Ask your doctor to suggest a screening plan if you have dense breasts or other risks for breast cancer.
General guidelines include a mammogram every other year after you’re 45 years old.
According to the American Cancer Society, women in a high-risk breast cancer group and women on hormone therapy should also get a yearly magnetic resonance imaging (MRI) scan. MRIs can sometimes be more helpful in evaluating very dense breasts.
It’s suggested that breast cancer develops in areas where the breast is dense, but more research is needed to see if there’s a direct relationship. Dense breasts mainly increase your risk for a missed diagnosis.
That’s because it’s harder for doctors to spot tumors on mammography. Dense breast tissue and tumors both show up white. Fatty breast tissue shows up as grey and black.
If you do have dense breasts, your doctor may recommend mammograms. Early diagnosis affects the outcome of breast cancer. Your doctor may recommend yearly mammograms and MRIs if you have other risk factors for breast cancer.
Keep in mind that studies define increased risk by comparing women with the highest breast density to women with lowest density category. The risks don’t necessarily apply to everyone across the board. Dense breasts are a common finding in many mammograms.
If you want to read the latest research and recommendations, the non-profit organization Are You Dense advocates for women with dense breasts.