Dense breasts contain more glands, ducts and connective tissue than fat. Breasts tend to be denser during a woman’s reproductive years; density makes it harder to detect suspicious lumps on a mammogram. Also, older women on hormone therapy often maintain high breast density.

“My right breast, the one I was worried about, turned out to be fine, but the MRI showed that in my left breast I had a tumor in excess of 5 centimeters that my mammogram and a clinical breast exam had missed,” Kovacs Myers says. (The disease is considered to be caught early when tumors measure 1 centimeter or less and have not metastasized or spread.) By the time it was detected, the invasive tumor had spread to 20 out of 26 lymph nodes on her left side. Kovacs Myers quickly underwent a lumpectomy to remove the harmful tissue and had chemotherapy and radiation. It was a close call.

“MRI saved my life,” she says. “I would be dead by now without it.”

A yearly mammogram is still the gold standard for breast-cancer screening and detection for women over 40 (or earlier for those at high risk for the disease). It’s the only test that has been scientifically proven to save lives. Still, it’s not always able to spot the disease in its early, potentially most treatable stages, especially if a woman has dense breasts.

The odds that a mammogram will fail to detect a cancerous lesion is small but significant. In general, the test is 83 percent sensitive, meaning that in large populations of women screened with mammography, it can miss cancer 17 percent of cancers. “But in women with very dense breasts, mammography will miss cancer 58 percent of the time,” says Thomas Kolb, M.D., a breast-cancer radiologist and leading ultrasound researcher in New York City.
Breast density depends in part on hormonal status, not necessarily weight, which is why premenopausal women are more likely to have dense breasts than postmenopausal women. Genetics also plays a part. It’s estimated that 62 percent of women in their 30s, 56 percent in their 40s, 37 percent in their 50s and 27 percent in their 60s have breasts that would be recognized as dense.

Ask your doctor for your breast-density measurement. It should be stated on your mammography report in one of four categories ranging from “fatty” to “extremely dense.” Anything other than “fatty” means a mammogram may be obscured to some degree.

Mammography also tends to miss lobular carcinoma in situ (LCIS), possible tumor precursors that mark women as high risk for breast cancer and lack the calcifications (calcium deposits that may indicate cancer), mass or density that would show up on a breast X-ray. Fortunately, in addition to MRI, there are other new tools that, used with a mammogram, serve to give a more precise diagnosis. “If you’re at high risk or you have dense breasts, you may be a candidate for one or more of them,” says Cheryl Perkins, M.D., the senior clinical advisor with the Susan G. Komen Breast Cancer Foundation, in Dallas, who advises you to ask your doctor about them. Here are four that may give you a clearer picture of your breast health—and could possibly save your life.

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Model: Bernadett
Wilhelmina 10/20 Division NYC
Photographer: Stanley Debas
www.debasphotography.com