CNN
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It is known that breast density naturally decreases as a woman ages, and now a study suggests that the longer it takes to decrease, the more likely a woman is to develop breast cancer.
Researchers have known for a long time that women with dense breasts have a higher risk of breast cancer. But according to the study, published last week in the journal JAMA Oncologythe rate of change in breast density over time also appears to be associated with the risk of cancer being diagnosed in that breast.
“We know that invasive breast cancer is rarely diagnosed simultaneously in both breasts, so it is not surprising that we have seen a much slower decline in the breast that ultimately developed breast cancer compared to the natural decline in density with breast cancer.” age”, Shu Jiang. , associate professor of surgery at Washington University School of Medicine in St. Louis and first author of the new study, wrote in an email.
Breast density refers to the amount of fibrous and glandular tissue in a person’s breasts compared to the amount of fatty tissue in the breasts, and breast density it can be seen on a mammogram.
“Because women get annual or biennial mammograms, the change in breast density over time is naturally available,” Jiang said in the email. “We should make full use of this dynamic information to better inform risk stratification and guide more individualized detection and prevention approaches.”
The researchers, from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston, analyzed health data over the course of 10 years among 947 women in the St. Louis region who completed screening mammograms. routine. TO Mammography is an X-ray image. that doctors use to look for early signs of breast cancer.
The women in the study were recruited between November 2008 and April 2012, and had had mammograms up to October 2020. The average age of the participants was around 57 years.
Among the women, 289 cases of breast cancer were diagnosed, and the researchers found that breast density was higher at the start of the study for women who later developed breast cancer compared to those who remained cancer-free.
The researchers also found that there was a significant decrease in breast density among all women over the course of 10 years, regardless of whether they later developed breast cancer, but the rate of density decrease over time was significantly slower among men. breasts in which cancer was subsequently diagnosed.
“This study found that assessment of longitudinal changes in breast density from digital mammograms may offer an additional tool for assessing breast cancer risk and subsequent risk reduction strategies,” the researchers wrote.
Breast density is not only a known risk factor for breast cancer, but dense breast tissue can make mammograms difficult to read.
“There are two problems here. First, the density of the breast can make it more difficult to ‘see through’ the breast on a mammogram, much like looking through ground glass. Therefore, it can be more difficult to detect a breast cancer,” said Dr. Hal Burstein, a clinical investigator at the Breast Cancer Center at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email. “Second, it is often thought that breast density reflects estrogen exposure or estrogen levels in women, and the higher the estrogen exposure, the higher the risk of developing breast cancer.”
In March, the US Food and Drug Administration released updates to its mammography regulationsrequiring mammography facilities to notify patients of the density of their breasts.
“Breast density can have a masking effect on mammography, where it can be more difficult to find breast cancer within an area of dense breast tissue,” Jiang wrote in her email.
“Even when the problem of finding it is removed, breast density is an independent risk factor for developing breast cancer. Although there is a lot of data telling us that dense breast tissue is a risk factor, the reason for this is not clear,” he said. “It may be that the development of dense tissue and cancer are related to the same biological processes or hormonal influences.”
The new study findings show that breast density is a risk factor for breast cancer, but women should also be aware of their other risk factors, said Dr. Maxine Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.
“It makes sense, to some degree, that the longer your breasts stay dense, theoretically, the more likely you are to develop cancer. And basically, it adds to the data that dense breasts are a risk,” Jochelson said, adding that women with dense breasts should request supplemental imaging when getting mammograms.
But other factors that can increase the risk of breast cancer include having a family history of cancer, drinking too much alcohol, having a biopsy of a high-risk lesion in the breast, or having a certain genetic mutation.
For example, women should know that “density may not affect your risk as much if you have the BRCA 1 or 2 breast cancer mutation because your risk is so high that it may not make it much higher,” he said. Jochelson.
Some ways of reduce the risk of breast cancer They include maintaining a healthy weight, being physically active, drinking alcohol in moderation or not at all, and, for some people, taking medications such as tamoxifen and breastfeeding their children, if possible.
“Breast density is a modest risk factor. The ‘average’ woman in the US has a 1 in 8 lifetime chances of developing breast cancer. Women with dense breasts have a slightly higher risk, about 1 in 6 or 1 in 7. Therefore, the lifetime risk increases from 12% to 15%. That still means that the majority of women with dense breasts will not develop breast cancer,” Burstein said in his email.
“Sometimes radiologists will recommend additional breast imaging for women with dense breast tissue on mammograms,” she added.
He US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women age 50 and older. The task force says the decision to start screening earlier, after age 40, “should be an individual one.” Many medical groups, including the American Cancer Society and mayo clinicemphasize that women have the option of starting screening with a mammogram every year starting at age 40.
“It’s also very clear that breast density tends to be highest in younger women, premenopausal women, and for almost all women, it tends to decrease with age. However, the risk of breast cancer increases with age. So these two things are a bit at odds with each other,” said Dr. Freya Schnabel, director of breast surgery at NYU Langone Perlmutter Cancer Center and professor of surgery at NYU Grossman School of Medicine in New York, who was not involved in the new study.
“So if you’re a 40-year-old woman and your breasts are dense, you might think that’s really age-appropriate,” she said. “The bottom line message that is very, very practical and pragmatic right now is if you have dense breasts, whatever your age, even if you’re postmenopausal, maybe even specifically, if you’re postmenopausal, and your breasts aren’t recovering. less dense in the way the average woman does, which really is a reason to seek additional imaging in addition to just the mammogram, to use additional diagnostic tools, such as ultrasound or perhaps even MRI, if there are other risk factors “.
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