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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

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Author/s: 
Dimitris Challoumas, Rohan Ramasubbu, Elliot Rooney, Emily Seymour-Jackson, Amit Putti, Neal L. Millar

Importance: There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.

Objective: To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.

Study selection: All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.

Data extraction and synthesis: This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.

Main outcomes and measures: Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.

Results: A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.

Conclusions and relevance: This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

Keywords 
de Quervain tenosynovitis DQT pain management Visual Analog Scale VAS Q-DASH corticosteroid injection CSI ultrasonography tendonitis

Final Update Summary: Abdominal Aortic Aneurysm: Screening

Author/s: 
U. S. Preventive Services Task Force

IMPORTANCE:

An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%.

OBJECTIVE:

To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening.

POPULATION:

This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years.

EVIDENCE ASSESSMENT:

Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits.

RECOMMENDATIONS:

The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement).

Keywords 
abdominal aortic aneurysm recommendation AAA ultrasonography risk smoke

Draft Recommendation Statement, Abdominal Aortic Aneurysm: Screening

Draft: Recommendation Summary

Population
Recommendation
Grade
(What's This?)

Men ages 65 to 74 years who have ever smoked

The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who have ever smoked.

B

Men ages 65 to 75 years who have never smoked

The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men ages 65 to 75 years who have never smoked rather than routinely screening all men in this group. Evidence indicates that the net benefit of screening all men in this group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of evidence relevant to the patient’s medical history, family history, other risk factors, and personal values.

C

Women who have never smoked with no family history

The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history.

D

Women ages 65 to 75 years who have ever smoked or have a family history

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women ages 65 to 75 years who have ever smoked or have a family history.

I

Keywords 
tobacco smoke ultrasonography
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