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Dense Breasts Are Common—Here Is What to Know

Author/s: 
Hannah S. Milch, Joann G. Elmore

What Is Breast Density and How Common Are Dense Breasts?
Breast density refers to the amount of dense tissue (like glands and fibrous tissue) you have compared to fatty tissue in your breasts. Dense breasts are very common. About half of all women have them.

Why Does Breast Density Matter?
Dense breast tissue makes it harder for doctors to see cancer on a mammogram because both appear white on the image. Even with dense breasts, mammograms are still the best screening tool for most women and can find most breast cancers. Having dense breasts also slightly increases your chance of getting breast cancer, but not enough on its own to put you in the high-risk category.

How Do I Know If I Am at High Risk for Breast Cancer?
Doctors look at your overall risk—not just breast density—to decide if you are at high risk. Some other important risk factors, beyond breast density, include:

Age: Most breast cancers happen in women older than 50 years.

Family history: Having a close relative (like a parent, sibling, or child) with breast or ovarian cancer—especially if they were diagnosed before 50 years of age—raises your risk.

Certain inherited genes: Some gene variations, like in BRCA1 or BRCA2, raise risk considerably.

Past breast biopsies: Some biopsy results, such as atypical cells, can increase your risk.

Hormone use: Using hormone replacement therapy may slightly raise your risk.

Doctors use special tools (called risk calculators) to estimate how likely you are to develop a disease. They give you a score, like a percentage. If your chance of getting breast cancer in your lifetime is 20% or more, you might be called high risk. Every woman should get a breast cancer risk assessment. It helps you and your doctor decide if you may benefit from extra screening tests.

What Should I Do If I Have Dense Breasts?
Talk to your doctor about all of your personal risk factors—not just breast density. Most women with dense breasts do not need extra tests beyond regular mammograms. If you are at high risk, your doctor may recommend extra screening tests, such as MRI (magnetic resonance imaging) or ultrasonography (this test can be used if MRI is not available, but it is not as accurate). Extra screening tests may lead to more false alarms (finding something that is not cancer), finding cancers that will not cause any problems (this is called overdiagnosis), more tests or treatments that you do not really need, higher costs that might not be paid by insurance, and more worry or stress.

Dense breasts are common and not usually something to worry about. Mammograms are the best way to screen for breast cancer. Extra tests are only needed if you have other risk factors that put you at higher risk. It is important to think about the pros and cons of extra screening based on your personal risk and values. Your doctor can help guide this decision.

Keywords 
breast neoplasms mammography ultrasonography Hormone Replacement Therapy Dense Breasts

Screening for Breast Cancer

Author/s: 
US Preventive Services Task Force

We all want better ways to find breast cancer early and save lives from this disease. Breast cancer screening can detect cancer early, when it’s most treatable. This guide is meant to help you and your health care professional understand the benefits and risks of breast cancer screening, including what age to start screening and how often people should be screened. This guide is not for women who have a BRCA gene variant, a history of chest radiation, or a personal history of breast cancer. These women should talk to their health care professional about how best to stay healthy.

Keywords 
breast cancer cancer screening mammography breast neoplasms Early Detection of Cancer

Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement

Author/s: 
US Preventive Services Task Force

Importance: Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate.

Objective: The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.

Population: Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer.

Evidence assessment: The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density.

Recommendation: The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).

Keywords 
breast cancer cancer screening breast neoplasms Early Detection of Cancer mammography

Discussions of Dense Breasts, Breast Cancer Risk, and Screening Choices in 2019

Author/s: 
Kerlikowske, Karla", C.M., Miglioretti, D.L.

Breast density, a radiologic term that describes the proportion of parenchymal relative to fatty tissue in mammograms, is a strong and prevalent risk factor. With increasing breast density, the risk of having a breast cancer masked or hidden on mammography increases, as does future breast cancer risk.1 Almost 50% of US women aged 40 to 74 years have dense breasts (an estimated 27.6 million women). The widespread incorporation of breast density information into screening mammography reports in 36 US states and suggestion to consider supplemental imaging has resulted in women raising questions about breast density and supplemental imaging with their clinicians.2 Thus, clinicians need to be knowledgeable of the clinical significance of breast density and how it may be useful when combined with breast cancer risk to inform screening discussions.

Keywords 
breast cancer Breast Radiologists Radiology mammography screening mammography
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