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The Results Are In: Screening with Dense Breast Tissue

October 6, 2016 12:59 PM with Dr. Georgia Spear

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We know that every woman has a unique shape, but many don’t realize how this can impact their test results.  Breasts with more tissue are denser, making a regular mammography difficult to read and increasing the risk of cancer. Fortunately, the latest technology, the whole breast ultrasound, provides a new level of detection for women with dense breast tissue. How do you know if you have dense tissue? What are the next steps if cancer is detected? Find out in our chat with Dr. Georgia Spear, Director of the Clinical Breast MRI Program at NorthShore. She will share her expertise on dense breast tissue screening and breast cancer diagnosis, and take your questions about general breast health.

Georgia Spear - 12:58 PM:
Good afternoon! My name is Dr. Georgia Giakoumis Spear and I am a radiologist at NorthShore University HealthSystem, specializing in Breast Imaging.My passion is taking care of patients and educating women on their personal breast health. I hope that you will find the information on today's chat helpful. Breast cancer is a prevalent disease and our mission is to find cancer early, when it's treatable and curable. We know that dense breast tissue limits our ability to detect cancer using screening mammography, the gold standard for screening. We are fortunate that emerging technologies are now available to help detect cancer. Welcome and I look forward to chatting with you today.

Kathryn (Moderator) - 1:00 PM:
Our chat on breast dense tissue and the whole breast ultrasound is now open. You can submit questions at any time during our chat.

  Kara (Evanston, IL) - 1:02 PM:
How can I get my doctor to order the whole breast ultrasound exam next year when I'm due for my yearly exam?
Georgia Spear
Great question. If you had your mammogram at NorthShore, the mammogram report would document your breast tissue type. If your breast tissue is heterogeneously dense or extremely dense, then the ABUS (automated breast ultrasound) could be a great supplemental screening exam for you. Please talk to your doctor about this exam. ABUS is not to replace your annual mammogram. ABUS (automated breast ultrasound) would be performed along with your mammogram to improve our ability to detect cancer and possibly decrease the chance that you may be called back from your screening exam as well.

  MaryAnne (Milwaukee, WI) - 1:07 PM:
How do I know if I have dense breast tissue?
Georgia Spear
Breast density is a term defined by your radiologist that describes the amount of fibrous and glandular tissue in your breast as compared to fatty tissue. Your radiologist will interpret your mammogram and report your breast density on your mammography report. Knowing whether you have dense breast tissue is important because it can mask cancer from being detected on your mammogram. You may benefit from supplemental screening. At NorthShore, we have been very successful with Automated Breast Ultrasound as a supplemental screening exam. Contact your doctor to find out about your breast density and if the ABUS (automated breast ultrasound) is right for you!

  Jessica (Skokie, IL) - 1:14 PM:
Is there a different standard for dense breast tissues for those with saline breast implants?
Georgia Spear
Great question. The recommendation is the same. We have many patients with breast implants. If you have dense breast tissue, you may also request supplemental screening with ABUS in addition to the mammogram.

  A - 1:18 PM:
I heard that tofu increases breast tissue to be dense. Is that true? Is there any way to decrease density through diet?
Georgia Spear
Breast density is unique to you, your genetics and your physical make up. As we age, in general, our breast density tends to decrease. We are not aware of any dietary changes that will decrease your density in a significant way.

  Kate (Northbrook, IL) - 1:24 PM:
Hi Dr. Spear, Is the new ABUS screening ultrasound beneficial for women with predominately fatty breast tissue? I realize the targeted population is for women with dense tissue, but with breast cancer being so prevalent, wouldn't the ABUS be valuable for all women?
Georgia Spear
Great question. We know that the ability of mammography to detect breast cancer in women with dense breast tissue is affected significantly. This is not the case for women with fatty breast tissue. The goal of a supplemental screening test is to detect clinically significant cancers that may be missed on a mammogram and the population at greater risk for this is the subset of women with dense breast tissue. In addition to the masking effect discussed earlier, dense breast tissue places a women at an elevated risk for developing breast cancer as well. I would recommend discussing your personal risk for breast cancer and your tissue type with your doctor to see if ABUS would be the right supplemental screening test for you.

  Michelle - 1:38 PM:
Does someone's time of the month affect their radiologist's ability to read the mammogram?
Georgia Spear
Good question. Timing of the menstrual cycle does not significantly affect our ability to interpret a mammogram.

  Maddy (Highwood, IL) - 1:42 PM:
I was told that I have dense breast tissue and was refused an MRI when I asked my doctor. Do you have any ideas about how I navigate around this, especially knowing that my mom has ovarian cancer, but has not yet tested for the BRACA gene?
Georgia Spear
Great question. Risk is essential in how we stratify our patients and determine what imaging studies are right for them. Breast MRI is utilized in the screening setting for women who have a greater than or equal to 20% lifetime risk for developing breast cancer, but the guidelines do not support annual MRI with mammography in women with a lifetime risk of less than 20% because the benefits of the screening study do not outweigh the risks. If you have a strong family history of breast or ovarian cancer, I would recommend a consultation with the High Risk Breast Clinic at NorthShore Evanston Hospital. Your personal risk will be assessed and the proper screening recommendations will be made.

  Elena (Evanston, IL) - 1:48 PM:
How can the whole breast ultrasound be done/ordered for patients with history of dense tissue. Should they avoid the mammogram altogether?
Georgia Spear
Another excellent question. The mammogram is the gold standard for breast cancer screening and we recommend that all women 40 years of age and over have an annual screening mammogram. The ABUS (automated whole breast ultrasound) should be performed in addition to the mammogram in women with dense tissue. The ABUS is NOT to replace the screening mammogram. Together, the mammogram and the ABUS exam help detect more breast cancers and also help reduce the chances that you will be recalled for additional imaging based on your breast cancer screening exams.

  Ofelija (Skokie, IL) - 1:53 PM:
Which is better for dense tissue after the mammogram: Ultrasound or MRI ? Thank you!
Georgia Spear
Ultrasound or MRI is recommended as a supplemental imaging study based on your personal risk for developing breast cancer. Risk is determined by a formula that takes into account, in large part your family history and estrogen exposure. Once that risk is determined, the recommendation for adding ultrasound versus MRI can be made. For women at average or intermediate risk for developing breast cancer, ABUS is recommended along with mammography if you have dense breast tissue. For women at high risk for developing breast cancer (lifetime risk of greater than or equal to 20% as determined by a risk assessment formula), mammography with MRI should be performed. Talk to your doctor about your personal risk. The High Risk Breast Clinic at NorthShore Evanston Hospital is an excellent resource.

  Martha (Northbrook, IL) - 1:58 PM:
Having dense breasts is the single item for me listed meeting the recommendation for possible breast ultrasound in addition to mammogram. All three of my siblings and both of my parents have been diagnosed and treated for one or more types of cancer each. None have had breast cancer. Does it seem appropriate for me to request a breast ultrasound in addition to my regularly scheduled mammogram?
Georgia Spear
Absolutely. If you have dense breast tissue, the ABUS (automated breast ultrasound) would be a great supplemental screening tool to improve our ability to see through the dense tissue and maximize our ability to find breast cancer.

Kathryn (Moderator) - 2:01 PM:
This will be the end of our chat. Thank you very much for your questions. If you would like to find out more about dense breast tissue and the whole breast ultrasound, or to schedule an appointment with a specialist, contact NorthShore's Center for Breast Health.

Georgia Spear - 2:10 PM:
Thank you all all of your excellent and thoughtful questions. I hope that you found this session informative.
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