Woman With Dense (Lumps) Breasts are More Likelihood of Breast Cancer After Mammograms ; A New Study Shown
A mammogram is the most effective way to find breast cancer early, up to 2 years before the lump is even large enough to feel. A mammogram is a special kind of x-ray of your breasts. The amount of radiation used in the x-ray is very small.
Mammograms detect cancer because cancer is denser (thicker) than the normal part of the breast. A radiologist will look at the x-rays for signs of cancer or other breast problems.
Causes of breast lumps include:
- Milk cysts (sacs filled with milk) and infections ( mastitis ), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
- Breast cancer , detectable by mammogram or ultrasound, then a biopsy. Men can get breast cancer.
- Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These tend to resolve on their own in a matter of days or weeks. If not, the blood may have to be drained by your doctor.
- Lipoma -- a collection of fatty tissue.
- Intraductal papilloma -- a small growth inside a milk duct of the breast. Often occurs near the areola, the colored part of the breast surrounding the nipple, in women between the ages of 35 and 55. It is harmless and frequently cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can be seen in cases of breast cancer, this must be evaluated by your doctor.
Cancer turns up five times more often in women with extremely dense breasts than in those with the most fatty tissue, a study shows, signaling the importance of a risk factor rarely discussed with patients.
On mammograms, fat looks dark, but dense tissue is light, like tumors, so it can hide the cancers. But this study confirms that cancers are also more frequent — not just hidden — in women with dense breasts.
That means that density is a true risk factor, along with other strong predictors like age and the genes BRCA1 and 2. Yet specialists say that breast density is rarely considered with other risk factors in discussions between doctors and patients.
"It's been ignored to an absolutely unbelievable degree," said study leader Dr. Norman Boyd at Princess Margaret Hospital in Toronto.
The Canadian study by cancer centers in Toronto and Vancouver focuses on how and when cancers were found over eight years in existing records of 1,112 women collected between 1981 and last year. It is being reported in Thursday's New England Journal of Medicine.
Breast density comes from the presence of more connective, duct-lining and milk-gland tissue than fat. But a woman can't judge her own density; it is routinely evaluated from a mammogram.
Previous studies had linked breast density to a higher rate of cancer, pointing to both masking and a separate biological risk.
In this study, women with at least 75 percent dense breasts showed five times more likelihood of cancer than women with less than 10 percent density.
The researchers went further by calculating just how many more cancers were found at screening, within the next year, and in the years afterward. Cancers found within a year were considered likely to be present, but masked, during the earlier mammogram. But a true biological risk was seen in cancers discovered by mammogram or long afterward.
In this study, cancers were 18 times more likely in women with the densest breasts within the first year after mammograms — the masking effect.
However, cancers in women with the densest breasts were also more than three times more likely to turn up at the time of screening and after the first year following a mammogram. That confirms and helps quantify the true biological link between density and cancer.
"I think the masking thing is important, and it does happen, but the most important thing is that this is an incredible risk factor," said Dr. Karla Kerlikowske, of the Veterans Affairs Medical Center in San Francisco, who wrote an accompanying editorial. "This probably counts for a large percentage of the cancer that's occurring."
Breast cancer is the illness that many women fear most, though they're more likely to die of cardiovascular disease than they are of all forms of cancer combined. Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. Although rare, breast cancer can also occur in men — in the United States, more than 200,000 women and around 1,500 men will develop the disease in 2005.Breast cancers are the second most lethal kind after lung cancers in women. About one in eight women will get invasive breast cancer during her lifetime, according to the American Cancer Society. Last year, roughly 41,000 U.S. women died of it. Worldwide, it kills about 370,000 women each year.
In this study, density of more than 50 percent accounted for 16 percent of all cancers and a quarter in women under age 56.
Robert Smith, a screening expert at the American Cancer Society, said this study and its predecessors will encourage a rethinking of cancer screening.
For now, women can ask their doctor about their breast density based on a mammogram and how it might affect their risk. However, experts say it's too soon for doctors to provide solid advice to individual patients.
For one thing, quicker, more accurate tools are needed to measure density. Some experts believe that ultrasound, magnetic resonance imaging or computerized mammograms may ultimately prove better at finding tumors in very dense breasts, but it's still unclear how much value each might yield for its cost.
"In a perfect world, I would have my wife do an ultrasound, MRI, and a digital mammogram," said Dr. Gary J. Whitman, a radiologist at University of Texas M.D. Anderson Cancer Center. He was not involved in the study.
Some believe lifestyle changes or even preventive drugs may one day be recommended to women with this risk factor.
Meanwhile, specialists hope to identify genes that promote density, because they might act as targets for cancer drugs.
In another study in the same journal, a research team at the University of Michigan described a newly identified set of 186 genes that appears to predict whether a breast tumor will spread. It's estimated that about 10% of breast cancer cases are hereditary (run in the family). In many of these cases, a person has inherited a gene from his or her parents that has mutated (changed from its normal form). This mutated gene makes it easier for a person to get breast cancer.
Other so-called gene signatures have been discovered for breast cancer, but this one is also linked to survival in lung, prostate and brain cancers.
Every month beginning at about age 20. At this early age, any small lumps are probably just normal breast glands and ducts. Over time you will get used to how your breasts normally feel so that you're able to tell if a new lump appears.
Check your breasts a few days after your period when your breasts aren't so sore. If you don't have periods or if they come at varying times, check your breasts at the same time every month.