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What Every Woman Should Know about Dense Breasts

Starting April 1 in California, legislation goes into effect saying that a radiologist must now inform a woman if she has dense breast tissue.
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    In the fight against breast cancer, women now have another powerful weapon – access to information that could make a significant difference in the detection of a cancerous tumor during a routine screening mammogram.

    Starting April 1 in California, legislation goes into effect saying that a radiologist must now inform a woman if she has dense breast tissue. This type of tissue appears white on a mammogram, unlike fatty tissue which appears dark. A tumor or areas of calcification also show up as white, making them harder to see when large areas of connective tissue, also white,  are present. The new legislation, now also in effect in four other states, says when a woman is given the results of her mammogram, she must also be informed in writing about her breast density level. With this additional information, she can then talk with her doctor about whether she should have additional screening tests such as a breast ultrasound which will be able to provide further information about areas the mammogram may not have detected.

    Why is this new law so important? First we know that dense breast tissue occurs in many women: about 40% in younger, pre-menopausal women and about 30% in older women. We also know that breast cancer occurs three to five times more in women with a breast density level of 50% or more. 

    Early detection, as in all cancers, is our best weapon for survival. That is why it is so important for women, especially those with dense breasts, to know that additional screening when used with a regular screening mammogram may give more conclusive information and thus help to detect a cancer in the early stages. When allowed to grow, most breast cancer tumors will double in size every 100 days, meaning that cancerous tissue can be present in the breast for several years before it is detected. 

    The timing of your mammogram may also aid in the detection of a tumor in dense breast tissue. Try to schedule your mammogram as soon as your period is over or at least 10 days before you ovulate when breasts are less dense and less tender. For women who are peri-menopausal and whose cycles are erratic, try to have your mammogram done when you are menstruating. 

    Regular screening mammograms remain a very effective and valuable tool for decreasing death from breast cancer. In addition, with today’s sophisticated tools such as digital mammography with computer aided detection technology (CAD), as well as automated breast ultrasound, radiologists are able to detect even more cancers at the earliest stages, especially in women with dense breasts.

    Guidelines for when women should start getting screening mammograms and how often have recently changed and can be confusing.  Please talk with your physician to see what is right for you, especially if you have a family history of breast cancer. For my patients, I recommend that average risk women begin getting mammograms at age 40 and continue every one to two until age 49. From age 50 to 70, a woman should have a mammogram every year. After age 70, a woman should consult with her physician as to how often she needs the screening.  If you have a family history of breast cancer, I recommend you start receiving mammograms 10 years prior to the age at which your relative developed cancer.

    As women, we need to be strong advocates for our own health. Because of breast cancer survivors and others who have fought for the right of women to be fully informed about their risks for breast cancer, women in California now have this additional opportunity to safeguard their health. Knowledge is power. Please stay informed and urge your friends to learn more about this important health topic. 

    Dr.  Prasanna Menon

    Dr. Menon is board certified in obstetrics/gynecology and is on the medical staff at El Camino Hospital. She has a private practice in Mountain View. She received her medical degree from Karnataka Medical College and completed her internship at Stanford University Medical Center.

    Help for a young mom

    In June 2011, Anjali Rao, Fremont, was just 37 years old. She was fit, didn’t smoke and ate well. The only reason she thought about her risk for breast cancer was when she remembered family stories about an aunt who had died young, perhaps of something that affected her chest or breasts, Anjali wasn’t sure. 

    Because of a possible family history of breast cancer, her ob/gyn, Dr. Prasanna Menon, suggested she go ahead and get her first mammogram even though she wasn’t yet 40, the time when women are advised to start getting screened. 

    “I thought she was just being extra cautious, but when I hadn’t done it at the time of my next visit, she pressed harder,” Anjali says. “She told me a mammogram is only good if you get one.”

    It’s a good thing she did. A digital mammogram, with computer aided detection technology, showed micro calcifications, which a biopsy showed to be DCIS (ductal carcinoma in situ which is abnormal cells inside a milk duct in the breast). DCIS is considered one of the earliest stages of breast cancer and is readily detected by screening mammograms.

    A subsequent MRI then showed a suspicious area in Anjali’s other breast. “I was so scared and worried,” she says. “My whole world had come crashing down around me. I had a family, with two young kids. Now we were talking about not just one breast involved but two! I was an emotional mess.”

    A biopsy of the second breast was clear, but the relief of finding out is not what Anjali remembers best about her experience. “I think the word went out among the team that this young mom really needs help. The pathologist called me right away to tell me that the cancer had been caught early and my chances were very good. My surgeon helped me sort through the treatment options. Everyone went above and beyond what I expected.”

    What meant the most to her, Anjali says, was the understanding and compassion of members of the staff at El Camino Hospital’s Breast Screening Center.

    “As I was debating whether to have a mastectomy or a lumpectomy followed by radiation, one of the technologist shared with me that she knew exactly how I felt. It turned out not to be just words. She herself had had breast cancer and a mastectomy.

    “Showing and telling me that I was going to get through this experience meant everything to me. I was impressed by how good she looked which helped me make the decision to choose mastectomy just as she had done.”.

    Anjali, who works part time as an intercultural trainer, is going for her yoga certification and plans to work with women who have experienced cancer just as she has.

    “So much changes when you have cancer, from how you feel emotionally to how you feel about your body. I was helped so much, and now I want to continue to help others in the same situation.”


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