You've probably seen the word "Fibroglandular Density" on your mammogram report. Or maybe your doctor told you something like, "Your breasts are dense." It's normal to feel a little scared and curious when you hear something like this. So, today we're going to talk about what fibroglandular density is and whether it has any impact on your health.
What exactly is Fibroglandular Density?
Simply put, fibroglandular density is a measure of the type of tissue in your breasts. This can be accurately determined with a mammogram. Our breasts are made up of three main types of tissue:
1. Fibrous connective tissue: These are slightly denser tissues . They appear white on a mammogram. It is precisely because of this white color that cancer cells also appear white, which can sometimes make it difficult to detect cancer. If you have a lot of this type of fibrous tissue in your breasts, we call it "high fibroglandular density," or "dense breasts."
2. Glandular tissue: This is also dense tissue . This is where the milk glands and milk ducts come in. This tissue also appears white on a mammogram, making it a bit more challenging to detect cancer. If there is a lot of this tissue, it is said to have high fibroglandular density.
3. Fatty tissue: This is not dense tissue . It appears black or translucent on a mammogram. This makes it easier to see white areas of tissue, such as cancer, against a background of fat. If your breasts are mostly fatty tissue, it means you have "low fibroglandular density."
So, fibroglandular density is the amount of fibrous and glandular tissue in your breasts compared to the amount of fatty tissue. This is sometimes called "breast density."
Should we be worried about this fibroglandular density?
In fact, fibroglandular density is important because it can be difficult for a radiologist to detect breast cancer on a mammogram if you have dense breast tissue. This is because both cancer and dense breast tissue appear white on a mammogram. This is called ``masking'' – meaning that a cancer can be ``hidden'' by dense breasts.
But, don't worry if your mammogram says "dense breasts"! It's not a big deal. Depending on your mammogram results and your risk of breast cancer, your doctor may suggest some additional tests to get a better picture of your breasts.
What are the things that affect breast density?
Having dense breast tissue is actually quite common. About half of women fall into this category. There are several factors that can contribute to your developing dense breasts:
- Age: Young women's breasts are usually thicker, but as they age, fatty tissue can increase and the density may decrease.
- Hormone medications: Some hormone treatments (e.g., hormones given for menopause) can cause breast density to increase.
- Genetics: If someone in your family has dense breasts, you are more likely to have them too.
- Body weight: In general, women with low body weight may have increased breast density, while those with higher body weight may have decreased breast density due to increased fatty tissue.
Your doctor will talk to you about your breast density and how it can affect cancer detection. If you have a low risk of breast cancer, having dense breasts may not be a big concern. However, if you are at high risk of cancer, your doctor will discuss additional breast cancer screenings with you.
What are the different types of fibroglandular density?
The density of your breasts is divided into four main categories, ranging from very low density tissue to very high density tissue.
What is "scattered fibroglandular breast tissue"?
Radiologists classify your breast tissue using a scale called the Breast Imaging Reporting and Data System (BI-RADS). This BI-RADS scale rates your fibroglandular density.
- "Scattered fibroglandular density" means that your breasts have a mixture of dense and fatty tissue, but the majority is fatty tissue.
- "Heterogeneously dense breast tissue" means that your breasts have a mixture of dense and fatty tissue, but the dense tissue is the most abundant.
When these two types are combined, they cover about 80% of the American population. Many women in our country can see these conditions.
Is diffuse fibroglandular density cancer?
No, not at all. It's just a measurement of your breast tissue. Having "diffuse fibroglandular tissue" means that there are areas of density on your mammogram that look dense. As mentioned earlier, both cancer and dense breast tissue appear white on a mammogram, so density is only related to breast cancer because it can be a little harder for a doctor to detect cancerous spots if you have dense breasts.
What medical conditions may be associated with fibroglandular density?
Your fibroglandular density is linked to your risk of breast cancer. There is now increasing evidence that as density increases, your risk of cancer may also increase to some extent . There are two main reasons for this:
1. Mammograms sometimes miss dense breast cancers: Dense breast tissue can cause a cancer to be missed on a mammogram. According to some studies, up to 27% of cancers in dense breasts can be missed on a mammogram.
2. Dense breasts are more likely to develop cancer: Although the exact reasons for this are not clear, someone with dense breasts is at a higher risk of developing breast cancer than someone with breasts that are mostly fatty.
How is fibroglandular density measured? What are those tests?
To find out your fibroglandular density, you will need to have a mammogram. A mammogram is a special type of X-ray that takes pictures of the inside of your breasts.
Depending on the type of breast tissue you have, more advanced imaging technologies may be useful to see if cancer is developing:
- 3D mammography (breast tomosynthesis): This uses a low dose of X-rays (about 1.5 to 2 times the radiation of a standard 2D mammogram) to take several pictures of your breast from different angles. These pictures are put together to create a three-dimensional (3D) picture of your breast. This is especially good for people with dense tissue, as it reduces the amount of tissue overlapping. This technology allows the radiologist to "scroll" through the dense tissue, so abnormalities can be seen more clearly.
- Breast ultrasound: This uses sound waves to take a picture of your breast tissue and display it on a screen.
- Breast MRI: This uses magnets and radio waves to record the structures inside your breasts and display the images on a screen.
- Molecular breast imaging (MBI): In this test, your doctor injects a radioactive tracer into a vein in your arm. This tracer travels through your bloodstream. A special camera records how the tracer reacts with cancerous and noncancerous tissue in your body. This reaction is shown on a screen differently between cancerous and noncancerous tissue.
Each of these tests has its pros and cons. For example, while MRI and ultrasound can detect cancers that mammograms miss, they can sometimes misidentify noncancerous cells as cancerous (called a ` false positive` ). Specialized equipment like 3D mammography can detect cancers that a traditional mammogram misses, but it uses slightly more radiation than a 2D mammogram. If you have a high risk of developing cancer, the additional radiation exposure can be risky. Also, the availability of these technologies and how much they cost vary depending on insurance.
Talk to your doctor about what screening options he or she recommends, based on your risk of developing breast cancer. The most important thing to remember is that the mammogram is still the gold standard for early detection of breast cancer. Other technologies, such as breast ultrasound and breast MRI, are in addition to, not in place of, a regular mammogram.
What questions should I ask the doctor?
Be sure to ask your doctor about your fibroglandular density. Once you know how dense your breasts are, ask how it affects your health. Here are some questions you can ask:
- What are my chances of developing breast cancer?
- Are my breasts dense?
- How does my breast density affect the results of a mammogram?
- What are the best types of imaging to detect cancer?
- What types of imaging do you recommend for breast cancer screening?
- Should I consider additional testing?
- How often should these tests be done?
Finally, the most important thing to remember!
When a doctor talks about fibroglandular density, it can be a little scary if you're worried about your risk of breast cancer. But you shouldn't worry about it unnecessarily. Your breasts are made up of a certain type of tissue that may or may not pose a challenge to cancer screening. Dense breasts, or high fibroglandular density, mean you may benefit from additional imaging tests to overcome some of the limitations of mammography. The most important thing is to see your doctor regularly, get your tests done on time, and follow his/her instructions.
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