March 11, 2025 • 19 mins
Nearly half of all women who get a mammogram for the first time will hear this from their doctor: You have dense breasts. But what does this mean? And should women who get this news be concerned? In this episode of Q&A with Dr. K, Dr. Doug Kuntzweiler and Dr. Tiffany Kniepkamp explain what it means to have dense breasts and the health implications.
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
Additional resources for this episode
Mayo Clinic - What it means to have dense breasts: https://www.mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968
Mayo Clinic - What to know about dense breasts: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/what-is-dense-breast-tissue-what-do-you-need-to-know
Centers for Disease Control and Prevention (CDC) About Dense Breasts: https://www.cdc.gov/breast-cancer/about/dense-breasts.html
American Cancer Society Breast Density and Your Mammogram Report: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/breast-density-and-your-mammogram-report.html
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Beth Brown (00:09):
Welcome to Q and A with Dr. K, a podcast by
Mountain Pacific Quality Health,where we sit down with Dr. Doug
Kuntzweiler and get your healthquestions answered, because on Q
and A with Dr. K, the doctor isalways in.
(00:34):
Hello everyone. This is BethBrown, your host. And thank you
for tuning in to Q and A withDr. K. And great news today, we
once again, have two times theexpertise to talk about our
question for today's episode.
Joining us are Dr. DougKuntzweiler and Dr Tiffany
Kniepkamp. So good to have youboth back.
Dr. Doug Kuntzweiler (00:52):
Thank you.
Dr. Tiffany Kniepkamp (00:53):
Thanks.
Good to be here.
Beth Brown (00:54):
So today's question applies to about two in every
Dr. Doug Kuntzweiler (00:55):
The first thing I would like to say is
that this is not a disease. It'snot an abnormality. It's like
the difference between blue eyesand brown eyes. Really, the
five women, so it's prettycommon, and what I'm talking
vision is the same. Breastfunctions the same. It doesn't
look any different, it doesn'tfeel any different, but it does
about today is dense breasts. Sowhat does a doctor mean when
have some important healthimplications for women. What it
means is that on a mammogram,there is more dense tissue, more
they tell a patient they havedense breasts? And how concerned
connective tissue, that shows upthan in a breast that is deemed
to be not dense. So this is sortof a subjective finding. You can
should a patient be to get thatnews? So let's start with what
only see it on a mammogram. Youcan't tell it any other way.
What it consists of is anincrease in some of the
does a doctor mean when they sayto a patient, you have dense
connective tissue in the breast,an increase in some of the
(01:15):
lobules, which are the milkproducing glands and the ducts.
breasts?
And the ducts are the tunnelsthat carry the milk from the
glands to the nipple so theinfant can get the nutrition.
And it's just an increase inthat. If you showed the same
mammogram to 10 differentradiologists, you might get two
or three different opinions onhow dense that breast was.
There's something calledBI-RADS, which women may see
when they get their mammogramreport, and that stands for
Breast Imaging and ReportingData System, and it is a system
that radiologists have agreedupon to try and classify these
varying degrees of density. Andother than the connective
tissue, I talked about, theducts and the lobules, most of
(01:35):
the breast tissue otherwise isfat, which gives the breast,
it's it's contour. So when theBI-RAD system the categories,
they've divided them into fourcategories. And the first is
category A, which is a breastwhich has mostly fat and very
little of the connective tissue.
Category B has scattered areasof increased density, and that
usually doesn't interfere withthe ability to read the
mammogram. Category C hasheterogeneous density, and that
means that there's densitypretty much throughout the whole
breast. And then Category D isextremely dense. And as I said,
this is not a disease, it's justsimply a variation, but the
denser the breast, the moredifficult it is on mammogram to
detect a suspicious area, todetect a cancer, and it also
(01:56):
does slightly raise a woman'srisk of breast cancer.
Dr. Tiffany Kniepkamp (02:21):
1.2 times more likely, I believe, is what
(03:58):
it was.
Dr. Doug Kuntzweiler (03:59):
I think that's right, I've seen various
numbers, but I think the takehome is that it does increase
your risk, although it's apretty slight increase, but it
does make it more difficult todetect a possible cancer.
Dr. Tiffany Kniepkamp (04:12):
Yeah, and Doug, going back a little bit,
when talking about the fourdifferent categories of density,
you may see on your mammogram,they'll talk about
fibroglandular tissue, and youdefinitely touched on this. But
just to even break it downfurther, it's really just like
you said, a fancy way todescribe parts of the breast
(04:32):
that aren't fat, so the fibroustissue is what helps support and
kind of hold the breasttogether. Think of it as like
connective glue that gives thebreast its shape, and then you
have the glandular tissue thatyou were talking about that
produces milk. And so thosetogether make up dense breast
tissue. And some women have moretissue than fat, which is why
(04:55):
they're considered dense. It'stotally normal, just something
to be aware of. And I do thinkwe're seeing this a ton, because
40 to 50% of women have densebreasts, and we start screening
at around 40, depending on riskfactors. And so if you start
screening at 40, you do havemore dense breast tissue when
you're younger. So at least inmy age group, I am getting so
(05:18):
many questions from my friends,and they're panicking because
they get these results saying, Ihave dense breasts. They want
more screening. They want to domore. Am I going to get cancer?
And everybody's very worried.
But I think the biggest thingis, it's, like you said, not a
disease. It's just something tobe aware of. So don't be
alarmed. Just be aware.
Beth Brown (05:38):
I was going to hit back on that, too, because we
definitely aren't trying toscare half of the women out
there who maybe have heard orwill hear this from a doctor, or
if they get a mammogram. It'snot a disease. But then the
other thing you talked abouttoo, Dr. K, is you kind of
compared it to the eye color. Sodoes that mean breast density is
(05:58):
genetic? Or what are the factorsthat play into whether or not
you're a woman who has densebreasts or not,
Dr. Doug Kuntzweiler (06:07):
It is largely genetic, and also, as
Tiffany talked about, age, theyounger the breast, the more
dense it's going to be. And thatgradually changes over time, and
changes pretty dramaticallyafter menopause. But it seems to
be mostly genetic. It's notanything that you've eaten or
any anything that you've donethat that caused it. I think
(06:28):
it's largely genetic.
Beth Brown (06:30):
So then, to that point, then, can women change
the density of their breast? Dothey have something that they
should be thinking about healthwise when it comes to that? Or
it really just is what it is.
Dr. Doug Kuntzweiler (06:42):
Well, it's interesting. The density does
change with a woman's menstrualcycle, and if you are taking
exogenous hormones, that means,if you're taking hormones as a
pill by mouth or a patch thatcan have an effect on it.
Dr. Tiffany Kniepkamp (06:56):
They actually have looked at
lifestyle changes. Diet andexercise really don't
significantly impact breastdensity. But that's interesting,
because more lean people do tendto have more dense breasts,
because they have decreased infatty tissue. When they look at
it, so say, you do do diet andexercise and you become more
(07:17):
lean, it actually doesn't changeit much. And so really, you're
looking at those hormonalchanges. So with aging, it's
just going to change, but youcan affect that. So stopping
that hormone replacement therapycan reduce your density. Aging,
like I said, naturally,decreases it. And diet and
exercise, like while it'swonderful and it decreases your
(07:38):
overall risk of cancers, doesn'tnecessarily change the density
of your breasts.
Dr. Doug Kuntzweiler (07:43):
One interesting side light to this
is there is a difference, andthis gets back to the genetic
component, there's a differencewhen you when you look at
various ethnic backgrounds. Forinstance, black women tend to
have less dense breasts, butthey do have a slightly
increased cancer incidencecompared to Caucasians and
Asians. Asian women tend to havedenser breasts, but actually a
(08:08):
lower risk for cancer comparedto Caucasians and Blacks. So
genetics is definitely playing arole in it, but it kind of
really muddies the waters.
Beth Brown (08:17):
Let's go back to something that you said,
Tiffany, about women who aregetting mammograms and they're
hearing this that they havedense breasts, is that how a
woman finds out she has densebreasts?
Dr. Tiffany Kniepkamp (08:30):
Yes, really, the only way to find out
is through mammogram and densitytesting. You can't necessarily
feel a difference. They don'tlook different. It is just the
rating they give it on amammogram.
Beth Brown (08:43):
Okay, and we've talked about that it can lead
potentially or make you athigher risk for breast cancer.
Is breast cancer our mainconcern here? Or are there other
issues related to their healththat women should be paying
attention to if they do knowthey have dense breasts?
Dr. Doug Kuntzweiler (08:59):
No, I think relative to dense breasts,
pretty much detection bymammography is the only real
issue. The breast doesn'tfunction any differently. And as
we said, your risk is raised,but only slightly. It's
interesting to me, the firstmammograms were done way back in
the early 1900s after, you know,xray was discovered, but it
(09:24):
really wasn't used for much ofanything until the 1960s. I went
to medical school and got intomedicine in the late 70s, and at
that time, as I recall, therewas not a lot of screening going
on. Mammography was used more ifa woman had a mass that you
could feel or a lump that feltsuspicious, then you got a
(09:45):
mammogram to see if it had anycharacteristics that might lead
you believe that was possibly acancer. But there wasn't a lot
of mass screening, and thatreally didn't happen, as I
recall, until maybe the late80s. It just wasn't commonly
done. But mammography, likeeverything else in medicine, has
(10:06):
gotten much more sophisticated,and initially it was done on
film, just like old x rays wereput on film, and now almost all
mammography is digital, whichhas improved the quality and the
ability to analyze themammogram, and I don't know
exactly what the prevalence is,but 3D mammography, which is
(10:29):
again, a more sophisticated wayto look at it, looking at it
from many different angles andconstructing a 3D image of the
breast, has helped quite a bit.
So if you're told that you havedense breasts, I think it would
be important to know exactlywhat technique they were using.
Was it a 3D study, and was itdigital?
Beth Brown (10:48):
So should women with dense breasts get more frequent
mammograms, or are there otherscreenings they should be
looking into, especially if, saythey know because of other risk
factors, they might have ahigher potential for breast
cancer?
Dr. Tiffany Kniepkamp (11:01):
Yeah, Beth, so you don't necessarily
have to get mammograms morefrequently, but as Doug
mentioned, you may benefit fromadditional screening, and your
doctor can talk you throughthis, depending on your risk
factors. A good way to thinkabout dense breasts is it gives
you an ever so slightly higherrisk of breast cancer. Think of
(11:23):
it as the same amount of risk asif a family member had cancer in
the past. That's about your risklevel. And so they'll take that
with other aspects of your riskfactors. Do you smoke? Do you
drink alcohol? Primary or firstcousin or parent, more immediate
family that had cancer, and thenthey'll determine if you need
(11:43):
further testing, because onthose mammograms. Dense tissue
shows up as white, and breastcancer shows up as white as
well. So you can imagine, ifyou've got very or extremely
dense breasts, it would bedifficult to spot a cancer
because it's all white. And sothey may recommend, like Doug
said, a breast MRI, 3Dmammography, there's breast
(12:07):
ultrasound, and then they canactually do contrast enhanced
mammograms as well. Not allfacilities offer that, and some
of these are not covered byinsurance yet, but they can help
to detect based on the riskfactors and what your doctor
recommends.
Beth Brown (12:24):
If a woman is diagnosed with breast cancer,
will her treatment be differentif she has deadness breasts?
Dr. Doug Kuntzweiler (12:30):
No, I would say it really doesn't
affect the treatment at all.
It's the same. It's just thedetection that is more
difficult.
Beth Brown (12:39):
And we know that men can get breast cancer too. It's
obviously not as common in menas it is in women. Can men also
have dense breasts?
Dr. Doug Kuntzweiler (12:50):
Breast cancer in men is exceedingly
rare, but it does happen, andthe normal male breast is pretty
much just all fat, but if youare developing a cancer, you do
show breast density on themammogram. It's difficult to do
on males, because there justisn't much tissue that you can
you can see to image, but it'susually palpable in a male, so
(13:14):
that's largely the way it'sdiscovered. But the male breast,
if it gets a cancer, does havemore density.
Dr. Tiffany Kniepkamp (13:20):
And I would say also, we don't
typically screen men. You know,we screen men for prostate
cancer, but we don't necessarilyscreen for breast cancer because
it is rare, and, like Doug said,more palpable usually. So you
will have signs, and it'll bebased on those signs that you
will determine if furtherimaging is needed.
Beth Brown (13:38):
I guess the bottom line then would be, what is the
key takeaway message? Going backto that original question of,
how concerned should a woman beto hear that she has dense
breasts?
Dr. Tiffany Kniepkamp (13:50):
I would say the bottom line, dense
breasts are not a disease. Halfof women who get their first
mammogram are going to hear thatthey have dense breasts, which
means half of your friends aregoing to say, what does this
mean? I would think of it as aheads up, not a warning sign.
And the good news is now thatyou know, you and your doctor
can stay on top of your breasthealth. Make sure you get breast
(14:12):
screenings, make sure you aredoing the correct screenings
based on your risk factors. Butreally, this is about awareness.
It's not about panic.
Dr. Doug Kuntzweiler (14:21):
I would say one of the problems with
increased screening or going toMRI or ultrasound is that both
of those have a fairly highfalse positive rate, so you may
wind up getting biopsies orneedle biopsies or open biopsies
or other technology that youreally don't need. I think if
(14:43):
you told you have dense breastsand there's some suspicious
areas at all, my recommendation,and actually my wife went
through that is I would find abreast surgeon, a surgeon who
specializes just in breasthealth, and see them and follow
their guidance. They're thepeople that have the most
experience at trying to figurethis out, especially if there's
(15:05):
high density in the breast, andalso some area that looks
suspicious, I think your yourbest move at that point would be
to go see a breast surgeon andlet them help you decide what
should be your next step.
Dr. Tiffany Kniepkamp (15:17):
And I would also say that if the
radiologist reads your mammogramand says you have dense breasts
and area with increased densitythat they recommend further
imaging. The typical next stepis an ultrasound. And I would
also say, don't panic on that,because about 50% - 40 to 50% of
(15:38):
women who have their firstmammogram are going to end up
also getting a breast ultrasoundto further look at things, and
it's just that initial screeningwhere they're getting a good
feel for what is going on withyour breast density and how to
proceed in the future. So I knowthat second image can be very
anxiety provoking for people,but I would think of it as,
(16:01):
again, just it's a heads up.
You're learning your breasts atthat age 40. Everybody's
figuring out exactly whatscreening they need to do, and
it's nothing to panic about. Ourtechnology has made such great
strides that we look for and wefind things, and we cause a
little bit of anxiety, sometimesover things that really are just
(16:22):
normal.
Dr. Doug Kuntzweiler (16:25):
Sometimes a lot of anxiety. There are
women who have had prophylacticmastectomies because it just
made them so anxious not knowingfor sure whether they they had a
cancer brewing or not. So wewant to try and avoid that if we
can.
Beth Brown (16:40):
So do your due diligence, but not any
differently than you wouldwhether your doctor said dense
breasts or not?
Dr. Doug Kuntzweiler (16:47):
Yeah, and don't be afraid to talk to your
doctor about it. Actually, don'tbe afraid to ask to talk to the
radiologist. There are states,many states now, that mandate
that a radiologist report towomen if they deem that she has
dense breasts, and, you know,recommending further studies,
but you shouldn't hesitate totalk to them about it. Talk to
your providers, talk to yourradiologist.
Dr. Tiffany Kniepkamp (17:09):
Yeah, and I would also say, talk to your
family. So I think you'd besurprised. If you turn 40, you
get your first mammogram, theysay you have dense breasts, no
matter the size of your motheror sisters, even if they're
bigger than you, smaller thanyou, ask them about it, because
you may find out they've haddense breasts their whole life
(17:29):
as well. And so it can put yourmind at a bit of ease too, as
there is just a geneticcomponent to it.
Beth Brown (17:34):
What about other websites or information out
there? Especially with as commonas this is, I would hope that if
a woman did want to learn alittle bit more for themselves,
where could they go?
Dr. Tiffany Kniepkamp (17:44):
So the Mayo Clinic always has wonderful
resources that are written inlayman's terms, and you can even
just search "dense breasts MayoClinic," and it will bring up
some good resources and answersto commonly asked questions. The
CDC and the American CancerSociety, they also have great
resources. There's also a breastcancer organization that
(18:07):
provides a lot of answers tothese questions, or some of the
most commonly asked questions.
So all of these are resourcesthat you can look into. And I'm
guessing Beth, we can put thosein the show notes.
Beth Brown (18:18):
Absolutely we can.
Would you add anything to that,Doug?
Dr. Doug Kuntzweiler (18:22):
No, I would encourage women to get
their screening. Don't beafraid. And if you get the
report that you have densebreasts, as Tiffany said, don't
be afraid. Talk to your doctors,talk to your family, and
proceed. You don't need to panicover it.
Beth Brown (18:37):
Be an empowered and active patient, which is a
message we have on here all thetime. So this is just another
example of that.
Dr. Doug Kuntzweiler (18:44):
Yes, don't be afraid to speak up.
Beth Brown (18:46):
Exactly. Well, thank you so much both for being here
today. We appreciate both ofyour time. And yes, as Tiffany
said, we will definitely getsome resources along with this
episode so you can learn more,if you would like. And if you
have a question for Dr. K foreither of the Dr. K's, please
email us atQandAwithDrK@mpqhf.org and we'll
(19:08):
have that email address withthis episode as well, and we
answer all those questionsanonymously. Thanks so much. Be
well.
Welcome to Q and A with Dr. K, a podcast by
Mountain Pacific Quality Health,where we sit down with Dr. Doug
Kuntzweiler and get your healthquestions answered, because on Q
and A with Dr. K, the doctor isalways in.
(00:34):
Hello everyone. This is BethBrown, your host. And thank you
for tuning in to Q and A withDr. K. And great news today, we
once again, have two times theexpertise to talk about our
question for today's episode.
Joining us are Dr. DougKuntzweiler and Dr Tiffany
Kniepkamp. So good to have youboth back.
Dr. Doug Kuntzweiler (00:52):
Thank you.
Dr. Tiffany Kniepkamp (00:53):
Thanks.
Good to be here.
Beth Brown (00:54):
So today's question applies to about two in every
Dr. Doug Kuntzweiler (00:55):
The first thing I would like to say is
that this is not a disease. It'snot an abnormality. It's like
the difference between blue eyesand brown eyes. Really, the
five women, so it's prettycommon, and what I'm talking
vision is the same. Breastfunctions the same. It doesn't
look any different, it doesn'tfeel any different, but it does
about today is dense breasts. Sowhat does a doctor mean when
have some important healthimplications for women. What it
means is that on a mammogram,there is more dense tissue, more
they tell a patient they havedense breasts? And how concerned
connective tissue, that shows upthan in a breast that is deemed
to be not dense. So this is sortof a subjective finding. You can
should a patient be to get thatnews? So let's start with what
only see it on a mammogram. Youcan't tell it any other way.
What it consists of is anincrease in some of the
does a doctor mean when they sayto a patient, you have dense
connective tissue in the breast,an increase in some of the
(01:15):
lobules, which are the milkproducing glands and the ducts.
breasts?
And the ducts are the tunnelsthat carry the milk from the
glands to the nipple so theinfant can get the nutrition.
And it's just an increase inthat. If you showed the same
mammogram to 10 differentradiologists, you might get two
or three different opinions onhow dense that breast was.
There's something calledBI-RADS, which women may see
when they get their mammogramreport, and that stands for
Breast Imaging and ReportingData System, and it is a system
that radiologists have agreedupon to try and classify these
varying degrees of density. Andother than the connective
tissue, I talked about, theducts and the lobules, most of
(01:35):
the breast tissue otherwise isfat, which gives the breast,
it's it's contour. So when theBI-RAD system the categories,
they've divided them into fourcategories. And the first is
category A, which is a breastwhich has mostly fat and very
little of the connective tissue.
Category B has scattered areasof increased density, and that
usually doesn't interfere withthe ability to read the
mammogram. Category C hasheterogeneous density, and that
means that there's densitypretty much throughout the whole
breast. And then Category D isextremely dense. And as I said,
this is not a disease, it's justsimply a variation, but the
denser the breast, the moredifficult it is on mammogram to
detect a suspicious area, todetect a cancer, and it also
(01:56):
does slightly raise a woman'srisk of breast cancer.
Dr. Tiffany Kniepkamp (02:21):
1.2 times more likely, I believe, is what
(03:58):
it was.
Dr. Doug Kuntzweiler (03:59):
I think that's right, I've seen various
numbers, but I think the takehome is that it does increase
your risk, although it's apretty slight increase, but it
does make it more difficult todetect a possible cancer.
Dr. Tiffany Kniepkamp (04:12):
Yeah, and Doug, going back a little bit,
when talking about the fourdifferent categories of density,
you may see on your mammogram,they'll talk about
fibroglandular tissue, and youdefinitely touched on this. But
just to even break it downfurther, it's really just like
you said, a fancy way todescribe parts of the breast
(04:32):
that aren't fat, so the fibroustissue is what helps support and
kind of hold the breasttogether. Think of it as like
connective glue that gives thebreast its shape, and then you
have the glandular tissue thatyou were talking about that
produces milk. And so thosetogether make up dense breast
tissue. And some women have moretissue than fat, which is why
(04:55):
they're considered dense. It'stotally normal, just something
to be aware of. And I do thinkwe're seeing this a ton, because
40 to 50% of women have densebreasts, and we start screening
at around 40, depending on riskfactors. And so if you start
screening at 40, you do havemore dense breast tissue when
you're younger. So at least inmy age group, I am getting so
(05:18):
many questions from my friends,and they're panicking because
they get these results saying, Ihave dense breasts. They want
more screening. They want to domore. Am I going to get cancer?
And everybody's very worried.
But I think the biggest thingis, it's, like you said, not a
disease. It's just something tobe aware of. So don't be
alarmed. Just be aware.
Beth Brown (05:38):
I was going to hit back on that, too, because we
definitely aren't trying toscare half of the women out
there who maybe have heard orwill hear this from a doctor, or
if they get a mammogram. It'snot a disease. But then the
other thing you talked abouttoo, Dr. K, is you kind of
compared it to the eye color. Sodoes that mean breast density is
(05:58):
genetic? Or what are the factorsthat play into whether or not
you're a woman who has densebreasts or not,
Dr. Doug Kuntzweiler (06:07):
It is largely genetic, and also, as
Tiffany talked about, age, theyounger the breast, the more
dense it's going to be. And thatgradually changes over time, and
changes pretty dramaticallyafter menopause. But it seems to
be mostly genetic. It's notanything that you've eaten or
any anything that you've donethat that caused it. I think
(06:28):
it's largely genetic.
Beth Brown (06:30):
So then, to that point, then, can women change
the density of their breast? Dothey have something that they
should be thinking about healthwise when it comes to that? Or
it really just is what it is.
Dr. Doug Kuntzweiler (06:42):
Well, it's interesting. The density does
change with a woman's menstrualcycle, and if you are taking
exogenous hormones, that means,if you're taking hormones as a
pill by mouth or a patch thatcan have an effect on it.
Dr. Tiffany Kniepkamp (06:56):
They actually have looked at
lifestyle changes. Diet andexercise really don't
significantly impact breastdensity. But that's interesting,
because more lean people do tendto have more dense breasts,
because they have decreased infatty tissue. When they look at
it, so say, you do do diet andexercise and you become more
(07:17):
lean, it actually doesn't changeit much. And so really, you're
looking at those hormonalchanges. So with aging, it's
just going to change, but youcan affect that. So stopping
that hormone replacement therapycan reduce your density. Aging,
like I said, naturally,decreases it. And diet and
exercise, like while it'swonderful and it decreases your
(07:38):
overall risk of cancers, doesn'tnecessarily change the density
of your breasts.
Dr. Doug Kuntzweiler (07:43):
One interesting side light to this
is there is a difference, andthis gets back to the genetic
component, there's a differencewhen you when you look at
various ethnic backgrounds. Forinstance, black women tend to
have less dense breasts, butthey do have a slightly
increased cancer incidencecompared to Caucasians and
Asians. Asian women tend to havedenser breasts, but actually a
(08:08):
lower risk for cancer comparedto Caucasians and Blacks. So
genetics is definitely playing arole in it, but it kind of
really muddies the waters.
Beth Brown (08:17):
Let's go back to something that you said,
Tiffany, about women who aregetting mammograms and they're
hearing this that they havedense breasts, is that how a
woman finds out she has densebreasts?
Dr. Tiffany Kniepkamp (08:30):
Yes, really, the only way to find out
is through mammogram and densitytesting. You can't necessarily
feel a difference. They don'tlook different. It is just the
rating they give it on amammogram.
Beth Brown (08:43):
Okay, and we've talked about that it can lead
potentially or make you athigher risk for breast cancer.
Is breast cancer our mainconcern here? Or are there other
issues related to their healththat women should be paying
attention to if they do knowthey have dense breasts?
Dr. Doug Kuntzweiler (08:59):
No, I think relative to dense breasts,
pretty much detection bymammography is the only real
issue. The breast doesn'tfunction any differently. And as
we said, your risk is raised,but only slightly. It's
interesting to me, the firstmammograms were done way back in
the early 1900s after, you know,xray was discovered, but it
(09:24):
really wasn't used for much ofanything until the 1960s. I went
to medical school and got intomedicine in the late 70s, and at
that time, as I recall, therewas not a lot of screening going
on. Mammography was used more ifa woman had a mass that you
could feel or a lump that feltsuspicious, then you got a
(09:45):
mammogram to see if it had anycharacteristics that might lead
you believe that was possibly acancer. But there wasn't a lot
of mass screening, and thatreally didn't happen, as I
recall, until maybe the late80s. It just wasn't commonly
done. But mammography, likeeverything else in medicine, has
(10:06):
gotten much more sophisticated,and initially it was done on
film, just like old x rays wereput on film, and now almost all
mammography is digital, whichhas improved the quality and the
ability to analyze themammogram, and I don't know
exactly what the prevalence is,but 3D mammography, which is
(10:29):
again, a more sophisticated wayto look at it, looking at it
from many different angles andconstructing a 3D image of the
breast, has helped quite a bit.
So if you're told that you havedense breasts, I think it would
be important to know exactlywhat technique they were using.
Was it a 3D study, and was itdigital?
Beth Brown (10:48):
So should women with dense breasts get more frequent
mammograms, or are there otherscreenings they should be
looking into, especially if, saythey know because of other risk
factors, they might have ahigher potential for breast
cancer?
Dr. Tiffany Kniepkamp (11:01):
Yeah, Beth, so you don't necessarily
have to get mammograms morefrequently, but as Doug
mentioned, you may benefit fromadditional screening, and your
doctor can talk you throughthis, depending on your risk
factors. A good way to thinkabout dense breasts is it gives
you an ever so slightly higherrisk of breast cancer. Think of
(11:23):
it as the same amount of risk asif a family member had cancer in
the past. That's about your risklevel. And so they'll take that
with other aspects of your riskfactors. Do you smoke? Do you
drink alcohol? Primary or firstcousin or parent, more immediate
family that had cancer, and thenthey'll determine if you need
(11:43):
further testing, because onthose mammograms. Dense tissue
shows up as white, and breastcancer shows up as white as
well. So you can imagine, ifyou've got very or extremely
dense breasts, it would bedifficult to spot a cancer
because it's all white. And sothey may recommend, like Doug
said, a breast MRI, 3Dmammography, there's breast
(12:07):
ultrasound, and then they canactually do contrast enhanced
mammograms as well. Not allfacilities offer that, and some
of these are not covered byinsurance yet, but they can help
to detect based on the riskfactors and what your doctor
recommends.
Beth Brown (12:24):
If a woman is diagnosed with breast cancer,
will her treatment be differentif she has deadness breasts?
Dr. Doug Kuntzweiler (12:30):
No, I would say it really doesn't
affect the treatment at all.
It's the same. It's just thedetection that is more
difficult.
Beth Brown (12:39):
And we know that men can get breast cancer too. It's
obviously not as common in menas it is in women. Can men also
have dense breasts?
Dr. Doug Kuntzweiler (12:50):
Breast cancer in men is exceedingly
rare, but it does happen, andthe normal male breast is pretty
much just all fat, but if youare developing a cancer, you do
show breast density on themammogram. It's difficult to do
on males, because there justisn't much tissue that you can
you can see to image, but it'susually palpable in a male, so
(13:14):
that's largely the way it'sdiscovered. But the male breast,
if it gets a cancer, does havemore density.
Dr. Tiffany Kniepkamp (13:20):
And I would say also, we don't
typically screen men. You know,we screen men for prostate
cancer, but we don't necessarilyscreen for breast cancer because
it is rare, and, like Doug said,more palpable usually. So you
will have signs, and it'll bebased on those signs that you
will determine if furtherimaging is needed.
Beth Brown (13:38):
I guess the bottom line then would be, what is the
key takeaway message? Going backto that original question of,
how concerned should a woman beto hear that she has dense
breasts?
Dr. Tiffany Kniepkamp (13:50):
I would say the bottom line, dense
breasts are not a disease. Halfof women who get their first
mammogram are going to hear thatthey have dense breasts, which
means half of your friends aregoing to say, what does this
mean? I would think of it as aheads up, not a warning sign.
And the good news is now thatyou know, you and your doctor
can stay on top of your breasthealth. Make sure you get breast
(14:12):
screenings, make sure you aredoing the correct screenings
based on your risk factors. Butreally, this is about awareness.
It's not about panic.
Dr. Doug Kuntzweiler (14:21):
I would say one of the problems with
increased screening or going toMRI or ultrasound is that both
of those have a fairly highfalse positive rate, so you may
wind up getting biopsies orneedle biopsies or open biopsies
or other technology that youreally don't need. I think if
(14:43):
you told you have dense breastsand there's some suspicious
areas at all, my recommendation,and actually my wife went
through that is I would find abreast surgeon, a surgeon who
specializes just in breasthealth, and see them and follow
their guidance. They're thepeople that have the most
experience at trying to figurethis out, especially if there's
(15:05):
high density in the breast, andalso some area that looks
suspicious, I think your yourbest move at that point would be
to go see a breast surgeon andlet them help you decide what
should be your next step.
Dr. Tiffany Kniepkamp (15:17):
And I would also say that if the
radiologist reads your mammogramand says you have dense breasts
and area with increased densitythat they recommend further
imaging. The typical next stepis an ultrasound. And I would
also say, don't panic on that,because about 50% - 40 to 50% of
(15:38):
women who have their firstmammogram are going to end up
also getting a breast ultrasoundto further look at things, and
it's just that initial screeningwhere they're getting a good
feel for what is going on withyour breast density and how to
proceed in the future. So I knowthat second image can be very
anxiety provoking for people,but I would think of it as,
(16:01):
again, just it's a heads up.
You're learning your breasts atthat age 40. Everybody's
figuring out exactly whatscreening they need to do, and
it's nothing to panic about. Ourtechnology has made such great
strides that we look for and wefind things, and we cause a
little bit of anxiety, sometimesover things that really are just
(16:22):
normal.
Dr. Doug Kuntzweiler (16:25):
Sometimes a lot of anxiety. There are
women who have had prophylacticmastectomies because it just
made them so anxious not knowingfor sure whether they they had a
cancer brewing or not. So wewant to try and avoid that if we
can.
Beth Brown (16:40):
So do your due diligence, but not any
differently than you wouldwhether your doctor said dense
breasts or not?
Dr. Doug Kuntzweiler (16:47):
Yeah, and don't be afraid to talk to your
doctor about it. Actually, don'tbe afraid to ask to talk to the
radiologist. There are states,many states now, that mandate
that a radiologist report towomen if they deem that she has
dense breasts, and, you know,recommending further studies,
but you shouldn't hesitate totalk to them about it. Talk to
your providers, talk to yourradiologist.
Dr. Tiffany Kniepkamp (17:09):
Yeah, and I would also say, talk to your
family. So I think you'd besurprised. If you turn 40, you
get your first mammogram, theysay you have dense breasts, no
matter the size of your motheror sisters, even if they're
bigger than you, smaller thanyou, ask them about it, because
you may find out they've haddense breasts their whole life
(17:29):
as well. And so it can put yourmind at a bit of ease too, as
there is just a geneticcomponent to it.
Beth Brown (17:34):
What about other websites or information out
there? Especially with as commonas this is, I would hope that if
a woman did want to learn alittle bit more for themselves,
where could they go?
Dr. Tiffany Kniepkamp (17:44):
So the Mayo Clinic always has wonderful
resources that are written inlayman's terms, and you can even
just search "dense breasts MayoClinic," and it will bring up
some good resources and answersto commonly asked questions. The
CDC and the American CancerSociety, they also have great
resources. There's also a breastcancer organization that
(18:07):
provides a lot of answers tothese questions, or some of the
most commonly asked questions.
So all of these are resourcesthat you can look into. And I'm
guessing Beth, we can put thosein the show notes.
Beth Brown (18:18):
Absolutely we can.
Would you add anything to that,Doug?
Dr. Doug Kuntzweiler (18:22):
No, I would encourage women to get
their screening. Don't beafraid. And if you get the
report that you have densebreasts, as Tiffany said, don't
be afraid. Talk to your doctors,talk to your family, and
proceed. You don't need to panicover it.
Beth Brown (18:37):
Be an empowered and active patient, which is a
message we have on here all thetime. So this is just another
example of that.
Dr. Doug Kuntzweiler (18:44):
Yes, don't be afraid to speak up.
Beth Brown (18:46):
Exactly. Well, thank you so much both for being here
today. We appreciate both ofyour time. And yes, as Tiffany
said, we will definitely getsome resources along with this
episode so you can learn more,if you would like. And if you
have a question for Dr. K foreither of the Dr. K's, please
email us atQandAwithDrK@mpqhf.org and we'll
(19:08):
have that email address withthis episode as well, and we
answer all those questionsanonymously. Thanks so much. Be
well.
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