Treatment for dense breast tissue -First and foremost, if you think you might have dense breast tissue, you should consult with your doctor to determine the exact type. This is usually measured by the ratio of the thickness of the breast tissue to the thickness of the breast tissue surrounding it. There are multiple degrees of denser breast tissue and they tend to fall into two groups.
First, the presence of significant lymph nodes in the breast tissue below the areola. While this is called invasive ductal carcinoma (or IRCC), it's a different type of breast cancer that's very treatable.
Second, dense breast tissue, also known as “dense breast disease.” Dense breast tissue is dense because it contains more fibroglandular tissue and less fat. There are many different types of dense breast tissue, and they all carry varying degrees of risk for breast cancer.
Most of the time, dense breast tissue is harmless. Sometimes, it's just dense, and there's nothing to worry about. In other cases, there is something to worry about. Dense breast tissue, and the three main types of it, are calcifications (decaying and non-renewing adipocytes), fibrocystic changes, and pre-cancerous (or tumor) cell changes.
The presence of significant lymph nodes in the breast tissue below the areola indicates breast cancer. These lymph nodes may be benign or cancerous and can be removed during surgery. In most cases, there is no need to do anything further with this breast tissue, but this cancer does have a high rate of recurrence. (Photo: Rohit Pramanik/Shutterstock)
While fibroglandular tissue can be found in the chest wall, it is not normal tissue and is usually in the shape of the breast or the nipple. It's also called clear chest wall breast cancer. Although it can occur anywhere along the breast, it's most commonly found in the chest wall and has a high rate of recurrence.
Second, dense breast tissue is primarily fat tissue.
“These tumors make up 10 percent of all breast cancers. And when people think of breast cancer, they think of the ACDA2 mutation, a BRCA1 mutation. People often wonder if they should have tests for the mutation, but often there is no reason to test,” Dr. Deanna Attai, an oncologist at Johns Hopkins School of Medicine, tells Goobie. “The majority of people have the mutation but don't have breast cancer. There's no association between that mutation and breast cancer recurrence or cancer prognosis. This is cancer that does happen.”
In many cases, a dense breast tumor can be successfully treated, but the risk is involved. Depending on the extent and size of the breast cancer, it can be difficult to remove the breast tissue around the tumor. Also, the tumor may recur. If there is any question that dense breast tissue is cancerous, you should always consult with your doctor first, since it's still cancer. And, depending on the tumor, there may be some options.
But, there are no options if you have dense breast tissue and you don't have breast cancer. This cancer is one you can't get rid of.
Certain types of fibrocystic changes can also be present in dense breast tissue, which can indicate cancer. Certain fibrocystic changes are more common in women with dense breast tissue, and can include:
- Cysts in the breast tissue
- Blisters (ductal carcinoma in situ)
- Epithelial changes like dilated ducts
- Adenomas, which are the most common benign type of breast tumor
- Breast pain or a feeling that something is stuck
- Swelling of the breast
Breast density should not be used as a measure of overall breast health. It's a risk factor, not a determining factor, and should be discussed with your doctor.
“This is cancer that does happen. It's cancer that does come back,” says Attai. “And that's the risk that we are trying to remove.”
If you're worried about your breast density and want more information, ask your doctor about having a regular exam with breast exam experts at your health care provider. Here are five things your doctor probably won't tell you, but should.
The study did not measure how much breast tissue a woman should have. But a recent large study published in the journal JAMA, which used self-reported data, suggests that breast tissue needs to be about 1 to 2 cup sizes larger than what women are typically described as having, using a standard formula called a Rankine scale.
Plus, most women have a little extra tissue, and studies show that this is normal. “How much tissue is normal is a matter of controversy,” said Dr. Jacqueline French, director of the cancer prevention and control program at the Jerome Lipper Inflammatory Breast Cancer Center at Fox Chase Cancer Center in Philadelphia, who was not involved in the guidelines.
However, as a woman's breast tissue grows to match the size of her chest, this tissue can sometimes become fibrous and connective — and in women who have never had children, it can also sometimes start to look lumpy or dark.
“The [USPSTF] now is going to ask if I feel like I have the fullness of my breasts or if they are the size they should be, and I say, ‘They are the size they should be,' and they say, ‘If they aren't, and they want them to be, then they should call us,'” French said.
What doctors usually tell women
Once doctors have determined the size and fullness of a woman's breasts, they can typically tell women how big they should be when compared with their chest size, French said. But with such a large sample size, there was no clear pattern between the size women were given and how common the resulting conditions were. Women with large breasts were more likely than those with smaller breasts to have skin tags, cysts, and fibroids (small growths of connective tissue).
Menstrual irregularities (like spotting and bleeding), but not breast growth, were more common.
“The fact that we saw such a wide range of conditions suggests that it's not just about breast size,” said Dr. Ali Tavakoli, chief of plastic surgery at Lenox Hill Hospital in New York City. “This is normal breast tissue.”
Ashkenazi women — Jewish women with straight hair — may also have larger breasts, but this is a genetic mutation, said French, who was not involved in the guidelines.
How other doctors may now advise women
In their updated guidelines, the USPSTF used three different-sized cup sizes to decide how large breast tissue should be.
For women with a normal mammogram, the researchers recommended the cup size that had the smallest amount of excess tissue. They recommend one cup size that is a little bit bigger than what the women in the study were advised to have,” French said.
Women who had false positives on mammograms — when a mammogram finds something that isn't cancer — may benefit from a different size.
The cup size that may be most useful is the small cup size.
For women who have dense breasts, a smaller cup size may help with some cancers, but for women who have dense breasts but not a lot of cancer, the size recommended in the guidelines may be too large, French said.
In those cases, a doctor may want to consider giving a patient a smaller cup size, French said, because cancer could grow in the small area that was not covered by the tissue.
Women who have had children might benefit from a slightly larger cup size.
Since these guidelines were originally published, the USPSTF has included information on women who have breast implants. That information, however, wasn't included in the study.
However, the researchers found evidence that women with implants are at a slightly increased risk for developing breast tissue asymmetry, where breast tissue grows asymmetrically, which can be a sign of cancer.
French recommended that women with implants not change the size of their implants unless there is reason to think it might help prevent breast cancer.
She also suggested that women who experience pain from their implants need to speak to their doctor and get an examination to determine whether the implants have fallen out, which could indicate a problem.
