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When he talks with women who have dense breasts, David Rippe, MD, assures them they don’t have a disease or a medical condition.
Having dense breasts is common: About four in 10 women have them.
“The problem, if there is one, is related to our imaging technology and the limited ability of mammograms to see through dense tissue,” says Dr. Rippe, co-medical director at the Simpson Breast Health Center at AdventHealth Zephyrhills.
Still, having dense breasts can affect a woman’s health in two ways. First, denser breast tissue is more difficult for a mammogram to see through. It appears as a white area, the same color as tumors, on a mammogram image.
Second, having dense breasts raises a woman’s risk for breast cancer.
Dr. Rippe says women deserve to know what dense breasts mean for them. In prior decades, the medical profession was not as communicative as it should have been, he acknowledges.
The Food and Drug Administration (FDA) is proposing new requirements for mammography screening that require notification about breast density. The FDA regulation comes after a number of states, including Florida, have passed laws requiring patients to be notified about what dense breasts mean for them.
Having dense breasts makes mammograms all the more vital. The Simpson Breast Health Center has a number of tools to overcome the limitations posed by dense breasts, including 3D mammography and ultrasound mammography.
AdventHealth Zephyrhills is also one of only a handful of hospitals in the state to offer Contrast-Enhanced Spectral Mammography (CESM). This technology uses an iodine-based contrast agent to make it easier to identify cancer in its earliest stages.
It is often used as a follow-up to a regular mammogram that has an abnormal finding. This is a stressful time for patients, but it can be done soon after the first mammogram — sometimes on the very same day.
What Are Dense Breasts?
A woman’s breasts are made up of many different kinds of tissues, like milk ducts, supportive tissue and fatty tissue. The amount of each varies for different women, and individuals can see changes over time.
Not all dense breasts are the same. There are four ways to categorize dense breasts, from “predominantly fatty” to “extremely dense.”
In some practices, the determination of a woman’s breast density is made by sight, as the radiologist looks at a mammogram.
The Simpson Breast Health Center uses a computer program to analyze a mammogram and report back the percentage of dense breast.
“We like it very much, because when you have an objective method you can be more consistent,” Dr. Rippe says.
Most women have dense breasts before menopause, but the percentage who have dense breasts afterward falls quickly.
For women with dense breasts, the real question is what they should do about it.
Technology Provides Options
Most healthy women should start getting their first mammogram at age 40. The goal is to spot a tumor early, before it causes any symptoms.
Having dense breasts doesn’t change the need to get a mammogram.
“The most important step that women can take, even with dense breasts, is to obtain a mammogram every year,” Dr. Rippe says.
The Simpson Breast Health Center uses a number of tools to help women with dense breasts:
- 3D Mammograms: This type of mammogram, which is given to all women, is better at seeing through dense breast tissue.
- Breast Ultrasound: Women who have dense breasts and other risk factors for breast cancer (like a family history or genetic vulnerability) may benefit from ultrasound.
- SenoBright Contrast-Enhanced Spectral Mammography: Similar to how dye is used in some CT scans, this procedure uses a contrast agent to show areas of increased blood flow. This picture is compared with one from a regular mammogram to highlight any areas of concern.
- Breast MRI: This technology, also offered to women at higher risk for breast cancer, uses magnets and radio waves to create detailed images.
Dr. Rippe also encourages women, including those with dense breasts, to perform self exams.
Other than that, he says there aren’t any lifestyle modifications — besides getting an annual mammogram — shown to help women with dense breasts avoid cancer.
The Simpson Breast Health Center has long put information about dense breasts into the report it gives patients. Dr. Rippe says the proposed FDA regulations are another step in the right direction.
“Open and honest communication is what we want,” he says. “Anytime a patient can have a greater understanding of their health and a plan of what we’re trying to accomplish together, it’s a great thing.”
The Simpson Breast Health Center, the only dedicated breast care center in east Pasco County, is focused on creating a calming, pain-free mammogram experience. That includes the latest exam rooms, with 3D mammography and patient-assisted compression, and a team of people to offer services to support you.