Personalized medicine and the dense breast.

What makes the density of the breast tissue important?  


If you have it, you may be more likely to have breast cancer, because several studies have shown that women with dense breast tissue have more breast cancers.  In addition, the best screening tool we have to detect breast cancers has limited value in dense breast tissue.  The mammogram "sees" only the most dense tissue between the X-ray source and the film, so anything of the same or lesser density is missed.


So, what do you do if you have dense breast tissue?  


For screening, I recommend mammogram plus ultrasound.  Many studies have demonstrated the benefits of whole breast ultrasound in dense breasts.  The ultrasound "sees" through the dense tissue and finds the mass (if there is one) when the mammogram can't.  In the 4 April issue of JAMA, an update of the American College of Radiology Imaging Network (ACRIN) 6666 study was published.  In this study, whole breast sonograms (ultrasounds) were offered to women who were at an increased risk for breast cancer and had heterogeneously dense breast tissue or dense breast tissue.  The ultrasound found 34% more cancers that were not "seen" on mammogram, in line with previous studies.  Other studies have also shown that the addition of ultrasound also detects smaller tumors, either doubling to tripling the number of tumors detected <10mm.  For more on this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822222/.


  
That is the screening issue.  If you have dense breast tissue you may benefit from whole breast sonography.  What about the prevention issue?  Of course you are already doing all the things mentioned in Monday's blog, but anything more?  You are already active, staying lean, exercising regularly!  Now for the personalization, where the doctor can make the recommendation unique to you.  If you have other risk factors, like a family history or high BREVAGen score, you might benefit from tamoxifen.  If you are postmenopausal and also have low bone density, then you might benefit from Evista.  If you are postmenopausal and on combined hormone replacement, you might benefit from weaning and eventually stopping the hormones.  You get the picture.  This personalization part requires the doctor visit.  That is where we doctors get to help you in your prevention plan.




Remember this is general information and intended to provoke a conversation with your doctor.  I am glad to help.  Feel free to call.  Personal medical information can only come from your doctor.






Together we can prevent 75,000 breast cancer cases each year!