Dense breast tissue is associated with up to a fourfold higher risk of breast cancer. However, a new study suggests that few women see breast density as a major risk.

The study, published in JAMA Network OpenIn the year From 2019 to 2020, 1,858 women aged 40 to 76 years had a recent mammogram, had no history of breast cancer, and reported hearing about breast density.

Women were asked to compare their breast density risk with five other breast cancer risk factors: first-degree relative with breast cancer, being overweight or obese, drinking more than one drink of alcohol per day, never having children, and having a breast biopsy.

“Compared to other well-known and perhaps more well-known breast cancer risks, women did not see breast density as a major risk,” said study author Laura Beidler, a researcher in health policy and clinical practice at Dartmouth. .

For example, dense breast tissue was associated with a 1.2- to four-fold higher risk of breast cancer, the authors reported. It was less dangerous.

Dense breast tissue refers to breasts that are composed of more glandular and fibrous tissue than fatty tissue. It is a common and common finding in about half of all women who undergo mammograms.

The researchers interviewed 61 participants who said they had been told about their breast density and asked them what contributed to breast cancer and how they could reduce their risk. While most women correctly perceived that breast density could mask tumors on a mammogram, few women felt that breast density was a risk factor for breast cancer.

A third of women thought there was nothing they could do to reduce their risk of breast cancer, including maintaining a healthy, active lifestyle and reducing alcohol consumption, although there are many ways to reduce the risk.

Breast density changes as a woman ages, and is generally higher in younger women, women who are underweight, pregnant or breastfeeding, or taking hormone replacement therapy.

Breast cancer risk increases with breast density; However, experts are not sure why this is true.

“One hypothesis is that women with denser breast tissue have higher levels of circulating estrogen, which increases the risk of breast density and breast cancer,” says breast doctor Harold Burstein. An oncologist at the Dana-Farber Cancer Institute who was not involved in the study. “Another hypothesis is that there is something about the tissue itself, which makes it denser, which somehow predisposes to the development of breast cancer. We don’t know exactly which explains the observation.

Thirty-eight states currently mandate that women receive written notification of their breast density and breast cancer risk after mammography. However, studies show that many women find this information confusing.

Although women are told in writing when they get a report of ‘increased breast density’ after a mammogram, it’s kind of placed at the bottom of the report. I’m not sure anyone can explain it, either physically or verbally, said Dr. Ruth Oratz, a breast oncologist at NYU Langone Perlmutter Cancer Center who was not involved in the study.

“I think what we learned from this study is that we need to do a better job of prescribing not just the general population of women, but the general health care providers who are working in primary care. A mammogram,” she added.

Current screening guidelines recommend breast cancer screening every one to two years between the ages of 50 and 74, with an optional starting at age 40.

Because women with dense breast tissue are thought to have a higher-than-average risk of cancer, women with high breast density may benefit from additional testing, such as a breast MRI or breast ultrasound, which can detect cancers missed on mammograms. Currently, coverage for additional screening after the first mammogram varies by state and insurance policy.

The authors warn that “more testing not only increases cancer detection rates, but also leads to more false positives and missed appointments.” They say clinicians should use risk assessment tools when discussing business outcomes associated with further testing.

“It’s usually a conversation between the patient, the clinical team and the radiologist. And in the past, if there’s anything else concerning on the mammogram, it’s affected by the patient’s family history. So those are the kinds of things we frequently discuss with patients in these situations,” Burstein said.

Breast cancer screening recommendations vary among medical organizations, and they say women at high risk due to breast density should discuss with their doctor what screening method and frequency is most appropriate.

I think it’s really important for everyone to understand — and that’s doctors, nurses, the women themselves — that screening is not just a one-size-fits-all recommendation. Single women have different levels of breast cancer risk, so we can’t give one general recommendation for the entire population,” Oratz said.

For the one-third of women with dense breast tissue who say there is nothing they can do to prevent breast cancer, experts say there are steps they can take to reduce their risk.

Maintaining an active, healthy lifestyle and reducing alcohol consumption addresses many modifiable conditions. Breastfeeding can reduce the risk. On the other hand, using hormone replacement therapy increases the risk of breast cancer,” said Dr. Puneet Singh, a breast surgical oncologist at MD Anderson Cancer Center, who was not involved in the study.

The researchers added that there are approved drugs, such as tamoxifen, which can be given to high-risk people and cut the risk of developing breast cancer in half.

Finally, breast cancer doctors say that in addition to proper screening, knowing your risk factors and advocating for yourself can be a powerful tool in preventing and detecting breast cancer.

“If a woman of any age is uncomfortable with what’s going on with her breasts, if she’s experiencing discomfort, if she’s noticed a change in her breasts, bring that up to your doctor and make sure he gets evaluated and don’t let someone just scratch you,” Oratz said.

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