It is a “hidden” risk factor that can increase a woman’s chances of developing cancer by six times. It cannot be seen or felt and fluctuates throughout life.
Women’s risk of getting cancer is six times higher than men’s
Starting this month, all women in the U.S. who get a mammogram — the type of X-ray used to screen for breast cancer — will be told about this specific risk: dense breasts. Breast density refers to the ratio of fat to glandular and connective tissue – the less fat, the denser the breast. The denser the breast, the greater the risk of cancer.
The US initiative comes after a campaign which patients say is vital to help women understand their overall risk of developing breast cancer – a disease which affects one in eight women. With this knowledge, women with dense breasts will be able to take steps to reduce their risk, such as maintaining a healthy weight and limiting alcohol consumption.
In Britain, however, if a woman is found to have dense breasts during a mammogram – offered every three years between the ages of 50 and 70 – it is not even mentioned in her medical record.
A review of screening protocols is needed
Now experts and campaigners in the UK are calling for a review of screening protocols as emerging research shows breast density could be a more significant predictor of breast cancer than family history.
They say hundreds of thousands of women are being left in the dark about their true breast cancer risk – and could have tumors repeatedly missed during routine scans.
“Women should be told about their breast densitysaid former breast surgeon Dr. Liz O’Riordan, who has had breast cancer three times.
“Evidence shows that women with dense breasts are more likely to get breast cancer. And in this case, knowledge is power.” say this.
Countryfile presenter Julia Bradbury, 54, has spent the past four years advocating for dense breast awareness alongside breast cancer treatment. She first felt a lump in her left breast in early 2020, but it took a year and three mammograms “CLEAR” until the tumor is discovered.
Breast tissue appears white on mammograms, as do tumors. It can be hard to tell the two apart on X-rays—indeed, mammograms fail to show lumps in up to half of women with dense breasts, according to research.
Julia told the Department of Health of her “disappointment” at the failure of the health service to protect the thousands of women who, like her, have repeatedly missed cancer.
“At one of my mammograms I was told I had dense breasts, but it wasn’t an official notification and it didn’t mean much to me“, she explained.
“Sounds pretty good at first, having dense breasts, doesn’t it? I didn’t fully understand the implications, the increased risk of cancer and the difficulty of detecting cancer with a mammogram. If I had known them earlier, I could have done more research and made an informed decision about what else to do. I would have pushed further, asked for more scans and asked why my doctors weren’t concerned.”she added.
Now she hopes Britain will follow America’s lead by requiring doctors to tell women about their breast density.
“The more people know about themselves, the more they can plan accordingly.” she said.
“And the earlier any cancer is diagnosed, the better the treatment options and outcomes.
“Every time I write a story about it, hordes of people — women and men — message me saying they’ve never even heard of dense breasts,” he continued.
11,000 women die each year from cancer
More than 55,000 women in the UK are diagnosed with breast cancer each year. And while nine out of ten survive, the disease still kills more than 11,000 each year.
“Dense breasts have nothing to do with how big your breasts are or how firm they feel, and the only way to know is to get a mammogram”says Dr. O’Riordan.
“They’re perfectly normal – in your teens, 20s and 30s, your breasts are naturally dense.
Glandular tissue produces milk, so it is needed when a woman is fertile. But as you reach menopause and your estrogen levels drop, your breasts naturally become less dense as the glandular tissue turns to fat.
“However, almost half of all women over 40 still have dense breasts – and some women in their 70s and 80s do too.” explained the doctorit.
Breast density is usually first noticed when a woman begins a breast cancer screening. For those with moderately dense breasts – around 40% of British women – the chance of developing cancer is double that of women with large breasts.
And for the 10% of women, research suggests the risk of cancer is six times higher.
“Dense breasts do not mean you will get breast cancer – it just increases your riskDr O’Riordan added. “Many studies show that over ten years, women with dense breasts are four to six times more likely to get breast cancer than someone with fat breasts. The frustrating thing is we don’t know why,” says the doctor.
Some theories link the high cellular content of dense breasts to a greater likelihood that abnormal cells will develop. Others think it could be due to higher levels of estrogen, the female sex hormone that also causes many breast cancers.
Whatever the truth, campaigners say that by not telling women about the density of their breasts – and not offering them MRI scans and ultrasounds, which are better at detecting tumors than mammograms – thousands of cancers are being caught far too late.
“It has been well known for many years that women would benefit from better screening“, explained Cheryl Cruwys, 58-year-old British breast density campaigner. “Still, women come to me saying, “If only I had known“.
The health system works differently in European countries
“In France, they automatically do additional screenings for women with dense breast tissue. In America, they now have to inform you of your relative risk. But in Britain, women are literally on their own. Ms Cruwys started the campaign – she founded the online resource Breast Density Info UK – after being diagnosed with breast cancer in 2016, aged 50.” writes the British publication DailyMail.
Living in France at the time, she went for her first routine mammogram without any concerns about her health. “I had no risk factors as far as I knew and when I had my mammogram it seemed clearshe said.
But in France, as in Austria and a number of other European countries, the health system works differently. Women who have dense breasts during a mammogram immediately receive additional screening – usually an ultrasound.
“In my case, the ultrasound found something the mammogram didn’t – an 8mm tumor” said Mrs. Cruwys. Now in remission, she considers herself “walking proof” of the importance of early detection.
“We know for a fact that if I had been in the UK when I had my first mammogram, my cancer would have gone undetected”she said.
For American campaigner JoAnn Pushkin, 64, it was this lack of transparency that led her to push for change in the country’s health policy. “The campaign was born from the grassroots efforts of women who were diagnosed with breast cancer at a later stage than neededr,” she told The Mail.
“We were never told that our breasts were dense, that it increased our chances of breast cancer, or that it drastically reduced the effectiveness of our mammograms.
So—with no family history of cancer—we went for annual mammograms, dutifully did self-exams, and yet our cancers were still missed year after year.
I have been going to annual screenings since I was 40 years old.
When I finally felt a lump, at age 45, the technician told me it had probably been growing for three to five years. And in every state I campaigned in, there were women with horror stories just like mine. Breast density is the only thing a doctor should tell us. We can’t find out on our own.” she added.
Women in the US are now told their breast density in a letter 30 days after their mammogram appointment using the density scoring system known as BI-RADS. It has four categories of variable density.
In addition to information, healthcare providers are also required to suggest that those with particularly dense tissue seek additional testing.
However, in the UK, there is no such scoring system: the first time a woman’s breast density will be officially recorded by the NHS is usually after she has been diagnosed with breast cancer.
Dr Fiona Gilbert, professor of radiology at the University of Cambridge and breast cancer expert, hopes that the UK’s breast cancer screening program will be updated to better care for women with dense breast tissue within the next five years.
“Policymakers are very aware of this issue of breast density and have either commissioned work or are waiting for test results to move forward and implement some changes.”she said.
In the US, where breast density is already accepted as a serious risk factor for breast cancer, celebrities have been talking about the importance of secondary screening for years.
Celebrities diagnosed with cancer
Country star Sheryl Crow, 62, who was diagnosed with early-stage breast cancer in 2006, has spoken at length about her experience of discovering she had dense breast tissue.
The singer had annual mammograms since she was 35 because her dense breasts made self-exams difficult and doctors caught her cancer early. Crow is now in remission.
Country star Sheryl Crow, 62, who was diagnosed with early-stage breast cancer in 2006, had dense breast tissue and is now in remission.
And TV presenter Katie Couric, 67, has written about having dense breast tissue on her website – revealing that she gets a routine ultrasound along with her annual mammogram. During one of these scans, her doctor found an abnormality in her breast, which led to her diagnosis of early stage breast cancer.
“Please get your annual mammogram”she advised readers in 2022: “But just as important, please find out if you need screening additional.”
