Breast Density

Breast density compares the amount of fat in the breast to the amount of tissue present. It is a measure used to describe mammogram images and is not a measure of how the breast feels (breast size and firmness). Breast tissue is made up of milk gland, milk ducts and supportive tissues (dense breast tissue) and fatty tissue (non- dense breast tissue).

Higher breast density indicates that the breast and connective tissue are denser when compared to the fat present in the breast. Lower breast density indicates more fat when compared to breast and connective tissue.

BIRADS or BI-RADS means Breast Imaging Reporting and Data System - a standard established by the American College of Radiology. This helps place findings from mammogram screenings into well-defined categories:

BI-RADS type 1: fatty; breast is almost entirely fat. Glandular tissue is less than 25%.

BI-RADS type 2: scattered fibroglandular; breast has scattered areas of fibroglandular density.

BI-RADS type 3: heterogeneously dense; breast tissue is heterogeneously dense.

BI-RADS type 4: dense; breast tissue is extremely dense. The breast contains greater than 75% glandular and fibrous tissue.

Dense breasts may be common and may not always pose a health issue. However women with high breast density are more prone to breast cancer when compared to women with low breast density. It is unclear as to why dense breasts may be more cancer prone. In a few cases women with low breast density are prone to develop breast cancer due to aging or menopause. 2/3 of pre-menopausal and 1/4 of post menopausal women (40%) have dense breast tissue.

A mammogram helps in identifying the density of breast. Women with dense breasts have more dense tissue than fatty tissue. Dense breasts look white or grey. Thus for women with dense breasts it may be difficult to identify cancer using a mammogram as both the dense breast tissue and cancer look grey or white in color in the image. Whereas for women with more fatty breasts it is easy to identify cancer as fatty tissues look black cancer look grey or white in color.

The 'success' rate of Mammogram detecting incidence of cancer depends on several factors:

patient age
breast density
tumor size
location
mammographic appearance

In younger women with denser breasts, mammography is less sensitive than in older women with fatty breasts where mammography can detect at least 90% of malignancies. Smaller tumors especially those without calcifications are more difficult to detect especially in dense breasts. Diagnostic mammography is associated with higher sensitivity but lower specificity as compared to screening mammography.

Factors that affect breast density

Factors increasing breast density

• High breast density is common among younger women and varies based on the age and weight of the woman.
  
  
• Pre-menopausal women tend to have dense breasts.
  
  
• Healthy women are more likely to have dense breast when compared to obese women.
  
  
• Lactation
  
  
• Mastitis
  
  
• Medication like menopausal hormone therapy or other medications that contain hormones may affect the breast density of a woman. These medications tend to increase the breast density of the woman.
  

Factors lowering breast density

• Breast density of a woman lowers as she gets older.
  
  
• Weight gain
  
  
• Acromegaly
  
  
• Vitamin D and calcium intake in pre-menopausal women
  

Women with high breast density

• Discuss after mammogram with their health care provider. In case the woman belongs to a high risk group classified based on gene mutation study or family history, then she should get an MRI done.
  
  
• Adapt a healthy lifestyle.
  
  
• Quit smoking
  
  
• Exercise regularly
  
  
• Limit alcohol consumption
  
  
• Eat a nutritious diet.
  
  
• Should undergo Breast Self Examination regularly.
  
  
• Get a doctor to examine the breasts every year.
  
  
• A digital mammogram every year from the age of 40.
  
  
• MRI and other imaging studies as per doctor recommendation
  

Fibrocystic Breast condition

Fibrocystic breast condition is a normal variant condition that many women face with their breasts. This condition is characterized by the presence of benign breast lumps and typically affects women in the age group of 30 - 50 years.

Fibrocystic breast disease is often referred to as chronic cystic mastitis or mammary dysplasia. Women suffering from Fibrocystic breast disease notice dense and irregular consistency in the breast tissue that is accompanied by dull pain and tenderness. Breast engorgement and nipple discharge is sometimes noticed. But it is essential that the symptoms of Fibrocystic breasts are not ignored as it might be a precursor to breast cancer. This condition can affect one or both breasts. The discomfort and swelling may be heightened prior to menstruation and taper off after that. The real cause for Fibrocystic breasts is still not completely understood but it is associated with ovarian hormones. Fibrocystic breast disease is characterized by pockets of irregularly-shaped cysts that lend a lumpy surface to the breast. These cysts are smooth and movable and make the breasts very tender. Sometimes the pain is severe prior to menstruation. In most cases, the condition disappears on menopause.

Fibrocystic breast condition can signal increased risk of cancer when accompanied by proliferative changes such as papillomatosis (skin lesion) or atypical epithelial Hyperplasia and increased breast density.

A physician will examine the breast masses and conduct a mammography to examine the tissues. Ultrasounds are useful in distinguishing cystic lumps from solid lesions. Often an aspiration of the cystic fluid may be necessary to diagnose the condition and drain the fluid. Usually Fibrocystic breast condition improves over time. Relief is sought by avoiding caffeine and aerated fluids. Pain relievers alleviate the tenderness and discomfort. Doses of Vitamin E are sometimes prescribed for women suffering from fibrocystic breast condition. Cold compresses on the tender breasts may offer relief. Sometimes surgical removal of the fibrocysts is undertaken. Hormonal therapy such as birth control pills and other medications that regulate estrogen and progesterone levels are sometimes resorted to.

Self Care tips

• Monthly BSE - Breast Self Examination
  
• Limiting dietary intake of saturated fats and salts
  
• Wearing a well-fitting bra