An NCI-designated Comprehensive Cancer Center
By Kevin Chesley | November 2, 2017
Every breast is unique, made up of both glandular tissue and fat. The ratio between the two becomes an important factor when it comes to correctly diagnosing the presence of breast cancer.
We spoke with Lusi Tumyan, M.D., a radiologist in the Department of Diagnostic Radiology and the chief of breast imaging at City of Hope, to find out more.

Dense Breasts

About 50 percent of women have what are called “dense” breasts, a term that describes breasts that contain more connective and fibro-glandular tissue than they do fat.
This condition, in and of itself, is not a health concern, Tumyan said. However, “There have been several studies that have shown that patients with dense breasts do have slightly increased risk of breast cancer compared to populations that do not have dense breasts,” she said.
What’s more, that cancer can also go undetected for longer, because fibro-glandular tissue makes cancer detection in self-exams more difficult.
“Having dense breast tissue sometimes masks smaller lesions and small cancers that develop because there is so much fibro-glandular tissue and so much connective tissue,” Tumyan said. “Detecting very tiny cancers is harder when women are doing breast self-exams.”
Tumyan also warns that dense breasts can even make professional mammograms much less precise.
“On a mammogram, fibro-glandular tissue and connective tissue shows up as white,” she said. “Unfortunately, cancer also shows up as that white. If a patient has a lot more fibro-glandular tissue than fat, sometimes the fibro-glandular tissue will mask the cancer which means that the radiologist is unable to pick up the cancer because there is a lot of tissue overlap and we just cannot see it.” 

State Notification

Some states, like California, have recently enacted laws that require that women with dense breasts are notified of the condition in writing. These notifications, which arrive as letters in the mail, can be a source of great anxiety and stress, Tumyan said. It’s important to know the facts about what can and should be done once they’re received.
Any woman notified about dense breasts should discuss their individual options with a physician, Tumyan said. In addition, she should find out as much as possible about her insurance company’s policies regarding dense breasts, since some insurers allow supplemental screening tests to be performed. 

Supplemental Imaging

Of course, Tumyan still advises women to continue performing self-exams and keeping mammograms a part of their routine.
“Mammograms are the best modality to identify breast calcifications associated with early breast cancer.” But for women with dense breasts, she also suggested two methods of supplemental imaging to compliment the mammograms: ultrasounds and MRIs.
“If a woman is determined to be of average risk for breast cancer based on their overall risk factors, ultrasound is a great supplemental examination in addition to a mammogram,” Tumyan said. “For patients that have high risk based on their overall profile, MRI is a great supplemental technique. It is very sensitive and very good at catching early breast cancer as a complement to a mammogram.”


Tumyan also advised that women should wait until after they’re done breastfeeding to schedule any of the above procedures.
“While women are breastfeeding, the glands, fibro-glandular tissue, everything increases – the breast becomes extremely dense,” she said. “It is extremely difficult to find cancers in those patients.” 
In short, Tumyan said, women with dense breasts should speak with their doctor about their options. A balanced discussion is needed to help determine risk and develop an individualized breast cancer screening program.
Learning that you have dense breasts isn’t a cause for anxiety, she said. It’s a call to action.  

Learn more about breast cancer and our breast cancer program. If you are looking for a second opinion about your breast cancer diagnosis or consultation about your treatment, request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.



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