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Q&A with Dr. Jessie Jacob on What it Means to Have Dense Breasts

Because there were so many interesting questions from the participants on GE Healthcare’s ‘Let’s Talk’ Dense Breasts Hangout, we asked Dr. Jessie Jacob, MD, MMM, Chief Medical Officer of Breast Health, GE Healthcare, and one of the panelists, to answer some of the most popular ones. Read on for more.

Dr Jacob Q&A

Dr. Jessie Jacob, MD, MMM, Chief Medical Officer of Breast Health, GE Healthcare.

Q: What are dense breasts?

Dr. Jacob: Breast density is a measurement of the amount of fatty tissue versus the amount of fibroglandular or connective tissue in the breast. Dense breasts is a classification that applies to breasts that contain more fibroglandular (glandular and connective) tissue versus fatty tissue that could potentially obscure cancers on mammography. Both cancer and dense breast tissue look white on mammograms, whereas fatty tissue appears dark, which means it can be more difficult to detect cancer on a mammogram for women with dense breasts. Here’s an image that shows a range of density starting with a mostly fatty breast on the left and a very dense breast on the right.

Breast density chart

Images shown from GE Healthcare mammography technology.

Q: Are dense breasts normal? Are they more cancer prone?

Dr. Jacob: Breast density is absolutely normal and not something you can control. About a third of women do have dense breasts, in fact. There are certain populations, such as East Asian women, who have a higher likelihood of having dense breasts. What’s important is to know that having dense breasts may increase your risk of breast cancer by up to 2-6 times and that it may impact your mammogram reading, so you can speak with your doctor about your risk factors and if alternate testing options are appropriate.

Q: What are the most effective technologies to screen for breast cancer and especially for women with dense breasts?

Dr. Jacob: The gold standard in breast cancer screening is mammography. As an adjunct to mammography, once a women has been identified as having dense breasts, Automated Breast Ultrasound (ABUS) from GE Healthcare is the only FDA-approved technology designed for screening women with dense breast tissue. It has been shown to improve detection by more than 35 percent over mammography alone. The key here is individualized care, an area we’ve made great progress in. Know your risk factors and speak with your doctor about the right testing options for you.

Q: How do we find out if there is an automated breast ultrasound (ABUS) available in our area?

Dr. Jacob: A great resource in general is knowyourrisk.gehealthcare.com. It will soon have a locator to help you find if an Invenia ABUS is located in your area.

Q: Does most insurance cover ultrasound testing if a mammogram indicates a woman has dense breasts?

Dr. Jacob: Insurance coverage varies. Check with your healthcare provider and your insurance provider to understand what testing will be covered and at what cost.

Q: Are there legislative actions being taken around dense breasts?

Dr. Jacob: There are efforts underway in 18 states across the US to enact legislation that would require women to be told if they have dense breasts and informed of alternate testing options. Below is the US map we shared during the Hangout that shows the status of this legislation.

US-ultrasound-screening-map-EDIT

Q: Should women refrain from consuming caffeine? What if they have dense breasts and/or breast cancer?

Dr. Jacob: Another good question that can also depend on your specific circumstance. If you have dense breasts or have been diagnosed with breast cancer, you should always feel empowered to ask your doctor about a nutrition plan for you. That being said, caffeine intake really hasn’t been shown to raise the risk of cancer. What it does is raise the risk of fibrocystic change in the breast, very common cysts or fluid-filled sacks in the breasts. These can cause more shadows on the mammogram images, which can cause additional unnecessary workup.

Q: Does weight gain or loss impact breast density?

Dr. Jacob: Because it is often easier to detect cancer in more fatty breasts when we look at mammogram images, weight gain can impact breast density in so far that, as women lose weight, the amount of fat decreases and it may become more difficult to detect cancer on the mammogram, and vice versa. That’s why we start with regular mammogram testing and individualize the care from there.

Q: Is there a link between the BRCA gene and density?

Dr. Jacob: Currently there isn’t a link between breast density and BRCA. What’s important here is the progress we’ve made in understanding the importance of genetic and other risk factors relative to breast cancer and density. In the past, we often saw a one-size fits all approach where all women received only a mammogram. Now, with more input and awareness, we have additional testing options following a mammogram which customizes the testing for women. So, if you know you carry the BRCA gene, this is certainly a topic to discuss with your doctor.

Q: How is breast density measured?

Dr. Jacob: This is still a developing topic that can vary between physicians. In general, it’s clear that certain breasts can be classified as “very dense” or “fatty.” It can be helpful to consult the breast density range shown in the first question here. Based on your mammogram, your doctor can determine if you have dense breasts, where you fall on this general spectrum and whether additional testing is appropriate.

 

The Invenia ABUS is indicated as an adjunct to mammography for breast cancer screening in asymptomatic women for whom screening mammography findings are normal or benign (BI-RADS Assessment Category 1 or 2), with dense breast parenchyma (BI-RADS Composition/Density 3 or 4), and have not had previous clinical breast intervention. The device is intended to increase breast cancer detection in the described patient population. The Invenia ABUS may also be used for diagnostic ultrasound imaging of the breast in symptomatic women.

This information is not medical advice and is for general information purposes only.  This information should not be relied upon as a substitute for consultations with qualified healthcare professionals.

More Information

‘Let’s Talk’ Dense Breasts: The Hangout