Decoding Dense Breasts on Mammograms Understanding Their Meaning and Importance

Hi, it's Dr. Jen. I want to talk today about what breast density is and what breast density isn't. Now you may have seen my quote in the Fox News article when the FDA mandated mammographic imaging centers to utilize the guidelines set forth by Birads, the Breast Imaging Reporting and Data Systems, the fifth edition in 2013, which talked about breast density. Now prior to that we named breast density by volume and this was an attempt to more standardize what we called dense breast. So if you had a Birads A, you had extremely fatty breasts. If you had a Birads B, you had scattered density in the breast. If you had Birads C, you had heterogeneous density in the breast. And Birads D is extremely dense. And when a woman hears that she has extremely dense breasts and that she's at increased risk of breast cancer, this is very scary to a woman. And no one really tells you what it is, what it means. And essentially what happens is that a door opens to a lot more imaging and unfortunately that is more to the benefit of, of the imagers and the system than it is to the person. So let's talk about the composition of breasts and what breast density means and specifically when breast density is meaningful. So when we talk about dense breasts, let's talk about the composition of the breast first. So, so the breast is made up of breast tissue or glandular tissue. This is the milk producing tissue and this is the tissue that is most prevalent in the premenopausal woman who is biologically prepared to feed a child. Now, in addition to the glandular tissue, there is fatty tissue and there is connective tissue that holds it all together and escape skin envelope. Now when we talk about dense breasts, what we're, what we're referring to is that glandular tissue and women who are pre menopausal, who are biologically able and expected to feed a child, are going to have predominantly dense breast tissue. So telling a premenopausal woman that she has dense breast tissue is like telling a premenopausal woman that she doesn't have much gray hair. Right? It's what you're supposed to have, it's what you're supposed to be, it's what you're supposed to look like. So telling a premenopausal woman that she has dense breasts and is therefore at increased risk of breast cancer is just simply untrue. Now, as a woman goes through menopause and the ovaries shut down and we have a decrease in circulating estrogen Your breasts will start to atrophy. And so it doesn't happen overnight, just like menopause doesn't happen overnight. It is probably a 10 year process. What we're looking for over that time period is for the breast to become less and less dense. Telling a premenopausal woman that she has dense breasts and is at increased risk for breast cancer is not only untrue, but it is inappropriate. I don't think that we should be giving those designations to premenopausal women because it's not meaningful. And in fact, we have studies that show that the only meaningful thing is that the breast tissue becomes less dense over time. So dense breast tissue in a post menopausal woman is a totally different story. So if the breasts are becoming more dense year after year after year, that is an indication that either that person is on hormone replacement and they are responding to the hormone replacement, or that postmenopausal woman has significant inflammation. It is a sign of underlying inflammation. And instead of just upping the screening, instead of just imaging that person more, what we should be offering that person is solutions. We should be talking to everyone who has dense breasts in the post menopausal position about an anti inflammatory diet, about moving every single day in a meaningful way, about managing stress, about prioritizing sleep, about eliminating toxins and especially environmental estrogens. And these are things like plastics and fragrance and antibiotics and PCAs, PCBs, phthalates, like all of these things that are found in body care products, in house cleaning products, in laundry detergent, and there's really plastics everywhere. We live in a highly, highly plasticized world. So eliminating those toxins, working on detoxification, the way that we detoxify is we sweat, we poop and we pee. And so making sure that all of those things are happening. And then the last thing is really living meaningfully and purposefully. And so if we are spending time talking to people about that as much as we are imaging them, their health would be better and we would not see the changes that we're seeing. So let's summarize. Dense breasts in a premenopausal woman does not mean anything other than they're premenopausal and they continue to have the ability to feed a child and they have the breasts to reflect it. The only thing that is meaningful is if those breasts do not become increasingly less dense over time. The only increased risk is dense breasts in the postmenopausal population. That is not becoming less dense with time. And it takes years for that to happen. So I hope that this was helpful for you, this was meaningful for you. And come back here next week for our next topic.