Study shows many women underestimate breast density as a risk factor for breast cancer

CNN
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Dense breast tissue is associated with up to four times the risk of breast cancer. But few women consider breast density to be a significant risk factor, according to a new study.

Research published in JAMA network opensurveyed 1,858 women aged 40 to 76 years from 2019 to 2020, reported having recently had a mammogram, had no history of breast cancer, and had heard of breast density.

Women were asked to compare their risk of breast density with five other breast cancer risk factors: having a first-degree relative with breast cancer, being overweight or obese, and drinking alcohol more than once a day. Beverage drinking, no children, previous breast biopsy.

“Women did not perceive breast density as a significant risk when compared to other known and perhaps better-known breast cancer risks,” said the study’s author, Dartmouth Health Policy and Laura Beidler, a researcher at the Institute for Clinical Practice, said. .

For example, the authors found that dense breast tissue was associated with a 1.2- to 4-fold higher risk of breast cancer, compared to a 2-fold higher risk associated with having a first-degree relative with breast cancer. However, 93% of women said having dense breasts was at low risk.

Dense breast tissue refers to breasts that are made up of more glandular and fibrous tissue than fatty tissue. This is a normal and common finding in about half of women undergoing mammograms.

The researchers also interviewed 61 participants who reported being informed about their breast density, asking what they believed contributed to breast cancer and what they could do to reduce their risk of breast cancer. I was. Most women are correctly aware that breast density may mask tumors on mammograms, but few feel that breast density may be a risk factor for breast cancer.

About a third of women say that although there are ways to reduce their risk, such as maintaining a healthy, active lifestyle and minimizing alcohol consumption, there is nothing they can do to reduce their risk of breast cancer. I thought no.

Breast density varies throughout a woman’s life and is generally higher in younger women, underweight women, pregnant or breastfeeding women, or women taking hormone replacement therapy.

The level of breast cancer risk increases with breast density. However, experts are not sure why this is true.

“One hypothesis is that women with denser breast tissue have higher levels of estrogen and higher circulating estrogen, which contributes to both breast density and the risk of developing breast cancer.” Dana-Farber Cancer Institute oncologists were not involved in this study. “Another hypothesis is that there is something in the tissue itself that makes it denser and somehow predisposes it to the development of breast cancer. I really don’t know.”

Thirty-eight states now require women to receive written notification of breast density and potential breast cancer risk after mammography. However, research shows that many women confuse this information.

“Women are usually notified in writing when they receive a ‘breast density increased’ report after a mammogram, but it’s kind of hidden at the bottom of the report. What does that mean?” , I don’t know if anyone has explained it to them, in person or verbally,” said Ruth Oratz, M.D., a breast cancer specialist at NYU Langone’s Perlmutter Cancer Center. He was not involved in the study. .

“What we have learned from this study is that there is a better way to educate not only the female public, but also the public of health care providers who deliver primary care, the public who order their screening. I think it means that you have to work. Mammogram,” she added.

Current screening guidelines recommend that women at average risk of breast cancer undergo breast cancer screening every one to two years between the ages of 50 and 74.

Because women with denser breast tissue are thought to have a higher-than-average risk of cancer, the authors of this study concluded that breast MRI can detect cancers missed by mammograms in women with denser breasts. suggest that breast cancer may benefit from adjunctive screening such as breast ultrasound. Currently, post-first mammogram supplemental screening coverage varies by state and insurance policy.

The authors warn that “additional screening may increase false-positive results and cancel appointments, as well as increase cancer detection rates.” They say clinicians should use risk assessment tools when discussing trade-offs associated with additional screening.

“Usually it is a discussion between the patient, the clinical team, and the radiologist. That’s the kind of thing that we talk about frequently with patients in that situation,” said Burstein.

Breast cancer screening recommendations vary by health provider, and experts say women at high risk because of dense breasts should discuss with their doctor which screening method and frequency is most appropriate.

“I think it’s really, really important for everyone, including doctors, nurses, and women themselves, to understand that screening is not a one-size-fits-all recommendation. Individual women vary in their level of risk for developing breast cancer.” It’s not possible to make one general recommendation for the entire population because it varies,” Oratz said.

About a third of women with dense breast tissue report nothing they can do to prevent breast cancer, but experts say there are a few things you can do to reduce your risk. It states that there is a step of

“Maintaining an active, healthy lifestyle and minimizing alcohol consumption can address some modifiable factors. Breastfeeding can reduce the risk. increases the risk of breast cancer,” said Puneet Singh, M.D., a breast surgical oncologist at MD Anderson Cancer Center, who was not involved in the study.

The researchers add that there are drugs, such as tamoxifen, approved that can be given to people at significantly higher risk, which may cut the chance of breast cancer by about half.

Finally, breast cancer doctors say that knowing your risk factors and advocating for yourself, in addition to proper screening, can be powerful tools in breast cancer prevention and detection.

“If a woman, regardless of age, feels uncomfortable with what is happening in her breasts, feels discomfort, or notices changes in her breasts, she should consult a doctor for an evaluation and Don’t leave it alone, someone will just wipe you out,” Olatz said.