Most women are unaware they have dense breasts until they reach the age of 45.
⚠️ Use discretion. Radiological breast images.
Dense breasts, with relatively little fat and more connective and glandular tissue, have the highest risk of cancer. The pattern of these tissues on a mammogram is difficult to distinguish from tumors—dense connective tissue and tumors both appear white against a dark background. Breast density usually decreases with age or body mass index (BMI) and increases with hormone replacement therapy. 
|Mostly Fat||Scattered Density||Heterogeneously Dense||Extremely Dense|
An estimated 66 percent of premenopausal women, and 25 percent of postmenopausal women, have breasts that are dense enough to interfere with mammogram accuracy. Studies show that having dense breasts raises the risk of developing breast cancer fourfold to sixfold, primarily because density can obscure tumors. [3,4]
In a study of 329,495 women undergoing screening mammography in the United States between 1996 and 1998, mammography had 24 percent less sensitivity with 8 percent less specificity. 
The potential of MRI for screening women with dense breasts remains controversial due to scant clinical evidence. It is possible that MRI could offer a cost-effective supplemental imaging option for dense-breast women. The goal is earlier detection of small and potentially more-aggressive lesions are missed in mammographically dense breasts.
Dynamic contrast-enhanced (DCE) MRI has the highest reported sensitivity of all diagnostic breast imaging modalities for detecting abnormalities. However, methods of MRI is an expensive option and measurement requires standardization and automation. 
Ultrasound vs. Mammography
Common concerns among patients include skepticism over accuracy of mammography (breast x-ray) screening. Should you have ultrasound or another supplemental screening? Ultrasound has advantages of not emitting ionizing radiation, being well tolerated by patients, and already being widely available. 
Google Health Artificial Intelligence Examines Breasts
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Studies have shown that ultrasound significantly increases detection of clinically important, small, invasive, node-negative cancers within dense breasts. This is because tumors appear dark in contrast to lighter glandular tissue. For orientation of anomalies, ultrasound usually supplements other imaging. 
Ultrasound has critics. “Screening [with] ultrasound may lead to unnecessary biopsies,” according to Brian Sprague, assistant professor of surgery at the University of Vermont. “There is a small chance it could save your life, but there is a much greater chance you will have a false-positive result.” Sprague favors tomosynthesis for women with dense breasts. 
Tomosynthesis vs. Mammography
Tomosynthesis obtains multiple mammographic images while the x-ray source travels in an arc over compressed breasts, allowing three-dimensional digital breast reconstruction, visualization, and diagnosis. In 2011, the FDA approved digital breast tomosynthesis for all clinical indications accepted for mammography, including screening. [2,8]
Women between the ages of 40 to 44 should have the option to start annual breast cancer screening with mammograms. According to the American Cancer Society, women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or may continue yearly screening. 
Breast Cancer Drugs May Severely Inflame Lungs
⚠️ October 2019 – The FDA warns that the commonly prescribed breast cancer therapies known as cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors may cause rare but severe inflammation of the lungs.
Healthcare professionals are advised to monitor patients on these drugs regularly for pulmonary symptoms indicative of interstitial lung disease (ILD) and/or pneumonitis, such as hypoxia, cough, dyspnea, or interstitial infiltrates on radiologic exams in patients. —Medscape
You cannot feel density. Only a mammogram reveals if patients have dense breasts. Therefore, most ladies are unaware of the diagnosis until they reach the age of 45, when mammograms are recommended or unless there is a family history that warrants earlier testing.
Because mammography equipment is more accessible and it identifies dense breasts, other imaging technologies, like ultrasound, are ancillary, rather than primary diagnostic tools. Tomosynthesis, if available, has FDA approval for screening. [8‑12] Look for the FDA MQSA Certificate at your facility. 
FDA MQSA Certificate
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- The breast density-breast cancer connection. 2011, harvard.edu/womens-health/the-breast-density-breast-cancer-connection Retrieved 19 Sep 2019
- The Risk-Based Breast Cancer Screening: Implications of Breast Density. Lee C, MD MS, Chen L, MD, and Elmore J, MD MPH. 2017, nih.gov Retrieved 19 Sep 2019
- Involution of breast tissue and mammographic density. 2016, biomedcentral.combiomedcentral.com/articles/10.1186/s13058-016-0792-3 Retrieved 19 Sep 2019
- Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Carney PA, Miglioretti DL, Yankaskas BC, et al. Ann Intern Med. 2003;138(3):168–175. nih.gov
- Alternative Screening for Dense Breasts: MRI. Christoph I Lee, MD MS, Linda E Chen, MD, and Joann G Elmore, MD, MPH. 2017, ajronline.org/doi/full/10.2214/AJR.14.13636 Retrieved 19 Sep 2019
- The Role of Ultrasound in Screening Dense Breasts—A Review of the Literature and Practical Solutions for Implementation. 2018, nih.gov
- Routine Ultrasounds for Women With Dense Breasts. 2014, webmd.com/women/news/20141208/are-routine-ultrasounds-for-women-with-dense-breasts-worthwhile#1 Retrieved 19 Sep 2019
- Breast Tomosynthesis. 2014, massgeneral.org Retrieved 19 Sep 2019
- American Cancer Society Guidelines for the Early Detection of Cancer. cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html Retrieved 19 Sep 2019
- Dense Breasts: Answers to Commonly Asked Questions. cancer.gov/types/breast/breast-changes/dense-breasts Retrieved 19 Sep 2019
- The Latest Mammogram Controversy: Density. 2012, online.wsj.com/article/SB10000872396390444246904577573181463638846.html Retrieved 19 Sep 2019
- Dense breast tissue: What it means to have dense breasts. mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968 Retrieved 19 Sep 2019
- Mammograms. orders.gpo.gov/fda-womens-health.aspx Retrieved 19 Sep 2019
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