Should women with dense breasts have more frequent breast exams?

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Alene Wright, MD from Medical Center of Trinity offers advice on preventative measures to take if you have dense breasts.
Kathleen V. Greatrex, MD
Diagnostic Radiology
If you have dense breasts, your doctor may recommend more tests in addition to your monthly self-exam and yearly clinical breast exam and mammogram.

Additional screening tests may include:
  • breast ultrasound to tell if a lump seen on a mammogram is a fluid-filled cyst or solid mass that could be a problem
  • magnetic resonance imaging (MRI) to give a clear detail of breast tissue, although it can't always tell you what is and what isn't cancer
If a screening test can't tell you that a spot seen on a mammogram is harmless, a biopsy can be done to test for cancer cells.

Always talk with your doctor about your breast density and cancer risk factors. This can help the two of you develop a personalized program for early detection. For most women, the yearly clinical breast exam and mammogram begin at age 40. For women with a family history or genetic mutation, testing may start earlier.

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.
All women should have a yearly breast exam by a health care professional starting at age 21 and all women should start doing monthly self exam at this age (see link on how to do breast self exam with confidence http://www.youtube.com/watch?v=0-hUROxC5Kw).

Breast density is determined by the mammogram. Most women start having yearly mammograms at age 40 (earlier if family history of early onset breast cancers). There is no way for a woman or a physician to determine if the breasts are dense on examination. Breast density is determined by the mammogram, and it is now standard to for the mammogram report to state if the breast is fatty or dense.

The answer to the question is that women between the ages of 21 and 40 should have a yearly exam by a health care professional and should do a monthly self exam. After age 40, if your mammogram report states that your breasts are dense, you should consider supplemental imaging to find small cancers that could have been missed on your mammogram. The two choices for additional imaging are screening breast MRI and screening breast ultrasound.

For most women a screening ultrasound is the best choice since it is very effective, well tolerated and relatively low cost. Ideally, the exam should be done yearly in addition to the mammogram, but for women without any known risk factors (such as a family history of breast or ovarian cancer) every other year is reasonable.

For very high risk women like Angelina Jolie, who was positive for the breast cancer gene, a yearly breast MRI should be done starting at age 25. Now that Angelina Jolie has had her mastectomies, screening MRI is no longer needed for her.

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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.