Are You Dense?

Breast density is a problem for two reasons. First, having increased breast density will increase your risk of developing breast cancer. Second, breast density makes breast cancers harder to find during screening. 

This is a cancer.

This mammogram was taken here at the clinic. The woman who had this mammogram was in her 50s and has a small (stage 1) breast cancer.  This client didn't have any symptoms. She came to see us for screening.

I knew that this finding was a cancer the moment I saw it. Notice the white spot surrounded by the star-like pattern.  The star-like pattern is called architectural distortion and is highly suggestive of cancer. Notice also the position of the finding. It is located behind the lighter tissue of the breast.  This is called an asymmetry, another highly suspicious finding.

No additional testing here was needed. This client went straight to biopsy, where this finding was found to be malignant.

This is also a cancer.

This is a mammogram performed in another patient without symptoms, also in her 50s. It is about the same size (stage 1) as the cancer found above. Now ask yourself, "Would I be able to find this cancer if the arrow was not there?" In my case, the answer is no. When I saw this mammogram, my first thought was that this study showed no findings suspicious for cancer.

What do you notice about this image? Why is the cancer so difficult to see? The reason is because the white background obscures the white cancer. This white background is called increased breast density. It camouflages the cancer making it hard to find.

This cancer was found on this mammogram only in retrospect. It wasn't easy. It took myself, two radiologists, and 15 minutes to find it. And we actually knew roughly where it was before we started. How did we know where to look? Because this cancer was not initially found on mammogram, it was found on ultrasound.

This is a cancer as well.

Here you see another small cancer (about 1/4") in a client with increased breast density. This was too small to feel. The cancer was not seen on her mammogram.

In spite of the client's density, this cancer was very easy to spot. It formed a dark spot that stood out from the grey and white breast tissue. Notice the black radial lines. This is architectural distortion, a finding easily seen on ultrasound. This image was clear enough that I was immediately sure that it was a cancer.

So with a negative mammogram, why did I do an ultrasound? Because I saw on mammogram that the patient had increased breast density.

This cancer was found only because an ultrasound was performed due to this client's increased breast density.

So what does this all mean? If you want to do everything you can to avoid an advanced breast cancer–something I would recommend–you absolutely need to know what your breast density is.  The way you find this out is to ask the provider that ordered your mammogram, or look at the letter that was sent to you about your mammogram results. In California, your letter is required by law to provide you information on your breast density. Of course, if you are screened by us, you will know your density before you leave the Clinic.

If your breast tissue is dense, you need additional imaging to make sure that your cancer is not being missed.  Ultrasound, as shown above, is a good choice, because it is fast, inexpensive, radiation free, and heavy metal free. 

Here at the clinic, we do additional imaging for women with increased breast density using automated breast ultrasound. We can schedule this on the same day as your mammogram and give you the results of both immediately. Please call us at (530) 243-5551 to schedule.