How can breast cancer be detected in dense breasts?

Dr. Kathleen V. Greatrex, MD
Diagnostic Radiologist

To detect breast cancer in dense breasts, doctors may recommend screenings beyond monthly self-exam and annual clinical breast exam and digital mammogram.

On a mammogram, fatty tissue appears dark. Dense tissue shows up white, just like cancerous tumors or other suspicious masses. Looking for a tumor within dense breast tissue can be like finding a snowball in a blizzard. Doctors don't want to miss anything, so they may recommend additional tests.

Additional screenings may include a breast ultrasound or magnetic resonance imaging (MRI). Each type of test shows breast tissue differently and finds things that the others don't.

  • An ultrasound can show if a lump seen on a mammogram is a harmless fluid-filled cyst or something solid that could be a problem.
  • An MRI shows clear detail of breast tissue. But it often can't tell you what is cancer and what is not. Most "abnormal" spots on MRI turn out to be harmless, especially in women with low risk for cancer.

If a screening test can't tell you that a spot is harmless, a biopsy can be done to test for cancer cells.

Talk with your doctor about your breast density and cancer risk factors to develop a personalized program for early detection.

To detect breast cancer in dense breasts, women with dense breast tissue may benefit from adding ultrasound or breast MRI (magnetic resonance imaging) to their mammogram for better cancer detection. Dense breast tissue (which has nothing to do with size or feel but rather how well a mammogram photo quality penetrates the breast tissue) can be defined from a mammogram. Dense tissue makes it harder to detect small cancers and also increases the likelihood of developing breast cancer—a double edge sword.

Dr. Amanda J. Morehouse, MD
Critical Care Surgeon

Women with dense breast tissue do not necessarily need more frequent exams. But in women with dense breast tissue, it's harder to find cancers mammographically than in women with low breast density. So they may not necessarily need more frequent breast exams, but they may need different types of screening. For example, the newest infrared imaging, known as thermography, may benefit mammograms. Women with dense breast tissue may also benefit from breast ultrasound. This is a second way to look through that dense breast tissue to make sure the mammogram is seeing everything.

Women with dense breasts also have a somewhat higher risk of developing breast cancer. This could be because they simply have more actual breast tissue relative to the fat in their breast, or there may be something inherent in the breast tissue itself that increases the risk but also makes it look dense on the mammogram. Women with dense breasts should also be more cognizant of their own breast self-exam.

We have digital mammography, which is kind of a computerized mammogram, and on top of that now, we have 3D or tomo-mammography, which allows us to look at denser breast tissue in three dimensions. So we've really increased our accuracy and our sensitivity with finding breast cancer. And then on the other end, once a woman's diagnosed with breast cancer—it's amazing, the amount of research that has been done in treating breast cancer. So we can tailor our therapies. We're much more successful at treating breast cancer and a lot of women are living well beyond their breast cancer diagnosis and treatment because of the treatments that are available.

The information, opinions, and recommendations presented in this article have been compiled from a podcast and are for general information only.

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911.This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

Dr. Anne C. Hoyt, MD
Diagnostic Radiologist

The most commonly used tool for detecting breast cancer in women with dense breasts is breast ultrasound. Unlike mammography, which uses radiation, breast ultrasound uses sound waves. This allows doctors to look through the dense tissue and potentially uncover a mass or underlying abnormality. Doctors use breast ultrasound especially to evaluate breast lumps in women who have abnormal mammograms.

Dr. Thomas M. Cink, MD

Dense breast tissue can raise your risk of breast cancer. In this video, Dr. Thomas Cink, MD, talks about whether you should get special tests if you have dense breasts.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Women who have dense breasts are at an increased risk for breast cancer. Regular mammograms have trouble seeing through denser breast tissue, but an alternative called digital mammography, in combination with an ultrasound or MRI, can help achieve more accurate results. Most women cannot tell on their own if they have dense breasts; a mammography would be the only way to know. Ask your doctor to tell you if you have dense breasts. A monthly breast self-exam is critical, as are regular screenings. This is equally important for all women.

Dr. Deanna J. Attai, MD

Currently, there are no simple answers on how women with dense breasts should approach breast cancer screening. One option is for women with dense breasts to undergo tomosynthesis, or 3D mammography. With tomosynthesis, we see the breast tissue in 1 millimeter slices in addition to the composite image. If there is tissue covering a tumor, it should appear on tomosynthesis.

For women with very dense breasts, doctors may recommend ultrasound imaging in addition to mammography. And for women with a breast cancer risk that is 20 percent or higher than average, breast magnetic resonance imaging (MRI) should be considered.

Increasingly, doctors are focusing on each woman’s individual risk factors to advise them on screening. Doctors and women also should discuss the fact that additional screening may produce a higher rate of false positives (areas that look suspicious but aren’t cancer), which can lead to additional tests and anxiety for the woman.

Doctors should consider family history, age, weight, whether or not the person used hormones, breast density and other factors we know can contribute to their risk of breast cancer. It’s also important that doctors have a discussion with women about the potential downsides of picking up every little thing.

This content originally appeared online at UCLA Health.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.