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This Q&A answers common questions about breast density and breast cancer screenings.

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No two breasts are identical, even on the same woman. They come in different sizes, different shapes and even different density. You can’t tell a breast’s density by looking at it or feeling it, but it’s completely normal to have dense breasts.

“Dense breasts may obscure an underlining breast malignancy/cancer. Therefore, it is imperative to have a clinical breast exam by a physician following a mammogram to complete the breast screening and surveillance process. At that time, you can discuss with your physician mammogram results, risk factors, and the possible need for advanced imaging. The American College of Radiology has recommended that women with dense breasts and a family history of breast or ovarian cancer should consider advanced imaging to include Ultrasound and/or MRI of the breast.”

-Everett J. Bonner, Jr., MD, FACS, Breast Surgery, General Surgery 

If you do have dense breast tissue, here’s what you need to know about breast cancer screenings.

Q: What are dense breasts?

A: All breasts are comprised of milk-producing glands, fibrous tissue and fat. If your breasts are mostly glands and fibrous tissue, they’re considered to be dense. If they’re mostly fat, they’re considered to be non-dense. About 10% of women have extremely dense breasts and another 10% have non-dense breasts. The other 80% fall somewhere in between.

Q: Why are dense breasts a challenge when it comes to mammography?

A: Non-dense areas in the breasts appear dark and transparent on mammogram images. Areas of concern – such as noncancerous lesions or masses due to breast cancer – show up as white. Because dense breast tissue blocks x-rays, it also appears white on scans. This makes it difficult for radiologists to determine if white areas are normal breast tissue or if they require further evaluation.

Q: What happens if my mammogram can’t be read accurately?

A: If a radiologist spots any areas of concern on your scan, or if they’re unable to distinguish between normal dense breast tissue and a mass, they’ll report the findings to your doctor who will likely order follow-up tests. These may include a breast MRI or breast ultrasound. If there is still concern after these other tests are completed, a biopsy may be suggested.

Q: When should I get mammograms if I have dense breasts?

A: The American Cancer Society recommends women at average risk for breast cancer begin yearly mammograms at age 45. They also suggest that women have a choice of whether to begin annual screenings between ages 40 and 45. If you are at an increased risk of breast cancer, you may need to be screened earlier or more often than the recommendations.

Dense breasts may slightly increase your risk of breast cancer, although it is not exactly known why, so it’s best to talk to your doctor about when to begin yearly screenings. Whether you have dense or non-dense breasts, maintain a yearly screening schedule and follow up with additional tests if recommended by your doctor.

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Date Last Reviewed: August 20, 2019

Editorial Review: Andrea Cohen, Editorial Director, Baldwin Publishing, Inc. Contact Editor

Medical Review: Perry Pitkow, MD

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