Are You an Asian Female? Then Chances Are, You Have Dense Breasts: Why It Matters

 

October is Breast Cancer Awareness Month, and this fact bears repeating: Breast cancer is the most commonly diagnosed cancer among Asian American women, according to the U.S. Department of Health and Human Services.

But did you know this:

* Asian women historically have denser breasts than other demographic populations.


* Dense breast tissue makes it more difficult to detect cancer on a mammogram.


* Having dense breast tissue is considered a “moderate” risk for getting breast cancer, according to the American Cancer Society. Some studies show that dense breast tissue increases breast cancer risk four to six times.

 

So what are dense breasts and how do you know if you have them? Read on.

 

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What are dense breasts?

Breasts consist of varying proportions of fat and glandular tissue. When there is more than 50 percent glandular tissue, a mammogram looks white and is considered dense. You cannot tell whether your breast is dense by feel or appearance or size. (In fact, more than 40 percent of all women in the U.S. have dense breasts, and women with large breasts are less likely to have dense breasts.) It can only be evaluated by mammogram.

Why are masses more difficult to detect in dense breasts?

Since masses or lumps also appear white on a mammogram, they are difficult to detect in dense breasts. However, that doesn’t mean you should stop getting mammograms if you have dense breasts. Experts emphasize that mammograms regularly find cancers in dense breasts.

What detection method works for dense breasts?

Mammogram remains the gold standard for breast screening for all women, according to Dr. June Chen, medical director of breast radiology at Breastlink at the Breast Care and Imaging Center of Orange County. Two additional screening options for women with dense breasts include a screening breast MRI for women at high risk (family history, etc.), or an automated screening breast ultrasound (ABUS) for average risk women.

Though studies have shown that an ultrasound or MRI scanning, in addition to a mammogram, is a better detection method for those with dense breast tissue, such MRIs and ultrasounds may also show more findings that are not cancer, which can result in more tests and unnecessary biopsies, according to the American Cancer Society.

 

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So why won’t my doctor give me an ultrasound or MRI instead?

You should talk to your doctor. According to Chen, health insurance covers the cost of a screening MRI for patients with a high risk for breast cancer, but may not cover ultrasounds and MRIs for women not at high risk. Additionally, experts do not agree what other tests, if any, should be done for women with dense breasts.

A recent federal bill, called the Breast Density Mammography and Reporting Act, was introduced this summer in the Senate, which would require physicians to notify patients if they have dense breasts and discuss their risk and additional screening options. It would also support research for improved screening options for women with dense tissue. The bill was assigned to a congressional committee, which will consider it before possibly sending it on to the House or Senate as a whole, and is supported by nonprofit and advocacy organizations, including the American Cancer Society Cancer Action Network, Breast Cancer Fund, Susan G. Komen for the Cure, and Are You Dense Advocacy.

In the meantime, what should I do?

Talk to your doctor about your risk factors and a plan for screening. While new federal guidelines now recommend screening to begin at age 50, most doctors still recommend annual mammograms starting at age 40. Continue to do a monthly breast self-exam, get regular exercise, quit smoking (or never start) and cut down on alcohol.

 

 

This story was originally published in our Fall 2014 issue. Get your copy here. 

 

 


The “Asian Women Don’t Get Breast Cancer” Campaign

Earlier in the month, we wrote about why Asian women need to care about breast cancer despite the myth that breast cancer is not a worry for Asian women. Luckily, we aren’t the only ones to take note of this issue.

 

The National Asian Breast Cancer Initiative is the first national organization dedicated to raising awareness that breast cancer is one of the leading causes of death among Asian women in the United States.

NABCI is a not-for-profit project put together by the efforts of Privy Groupe, the Asian Pacific Community Fund, the Asian and Pacific Islander National Cancer Survivors Network and the Asian & Pacific Islander American Health Forum.

This month, timed perfectly with breast cancer awareness month, NABCI is creating a social media campaign called the “Asian women don’t get breast cancer” campaign which aims to shine light on the relationship between Asians and breast cancer.

The title of the campaign is honor of  breast cancer activist Susan Shinagawa:

In 1991, Susan noticed a lump in her breast during her monthly self-exam. Her mammogram came out negative, but a sonogram revealed that the lump was a solid mass.  Two doctors in different states diagnosed Susan with fibrocystic breast disease–lumpy breasts–and both initially refused to do a biopsy because, “Asian women don’t get breast cancer.” After the biopsy, Susan was diagnosed with invasive breast cancer and opted for a modified radical mastectomy of her right breast and six months of chemotherapy. Ten years later, a routine mammogram revealed that Susan had an unrelated breast cancer in her left breast, for which she underwent a second mastectomy.

Susan is still in active treatment and has become one of the nation’s leading Asian breast cancer activists.  Susan helped co-found the Asian & Pacific Islander National Cancer Survivors Network (APINCSN), which is a partner of NABCI.  To this day, Susan still meets Asian women (mostly young) diagnosed with breast cancer who were initially told by their healthcare providers that “Asian women don’t get breast cancer.”

 

To make a direct donation to NABCI, checks can be made payable to the “Asian Pacific
Community Fund FBO NABCI”.

Asian Pacific Community Fund
1145 Wilshire Blvd, Suite 105
Los Angeles, CA 90017

All funds will be used towards the following goals:
● build a multi-language information and resource directory website at  asianbreastcancer.org
● produce printed in-language materials that can be distributed to breast cancer outreach centers throughout the U.S.
● solicit and create a Youtube channel for Asian breast cancer survivor stories in multiple languages
● create a medical exchange for U.S. and Asia-based breast cancer doctors to share best practices for detecting and treating breast cancer for Asian women
● organize a national breast cancer awareness campaign targeting Asian women in the U.S. (especially immigrants)
● become an advocate for public policy and research that relate to breast cancer and Asian women in the U.S. and abroad

 

Remember to check out all the reasons this issue needs to be recognized in our community. Tell your loved ones to get checked and help spread the word! Like this campaign on facebook.com/asianbreastcancer and follow them at @aznbreastcancer. Find out more at  www.asianbreastcancer.org

 

The Truth About Mammograms: To X-Ray or Not To X-Ray?

Story by Anna M. Park. 

When the U.S. Preventive Services Task Force announced that women should not be getting mammograms until they reach 50, it ignited controversy within the medical community. For years, doctors have insisted on mammograms starting at 40, and the American Cancer Society and Susan G. Komen Foundation still recommend an annual mammogram starting at the age of 40, citing early detection key to saving lives. Just do a quick search and you’ll find stories of all sorts of young women in their 40s whose lives were saved from early detection. Nonetheless, most major health organizations have concluded that the modest survival benefits of mammography in women ages 40 to 49 outweigh the risks of false positives and further unnecessary procedures. So what’s a woman to do? Dr. Maggie DiNome, chief of General Surgery at Saint John’s Hospital in Santa Monica, Calif., who specializes in breast cancer surgery, answers our questions.

Q. My OB/gyn insists I get annual mammograms starting at 40, even though I have no family history. But the new U.S. Preventive Services Task Force recommends mammograms starting at 50, and then every two years. What do I do?

Dr. Maggie DiNome: You would need to weigh the data to know what is right for you. The U.S. Task Force came out with their consensus statement based on their recommendations of what is most efficient for screening, meaning what has the biggest bang for the buck for the population as a whole. According to their review of the existing data, starting mammograms at age 40 only results in one life out of 1,000 being saved. That might not seem like much, but if you were that one patient, it means the world.

So what is the trade-off for starting mammograms at age 40? Well, the argument is that it leads to more false positives, which leads to more unnecessary biopsies and imaging. It may also be finding stages of “cancer” (i.e. DCIS, or ductal carcinoma in situ) that truly do not need treatment, although currently we treat everyone diagnosed with DCIS because we don’t yet know who can safely avoid treatment. As a breast surgeon, I see more than one might expect of breast cancers diagnosed by routine mammograms in women in their 40s, so it’s hard for me to say “stop.” I wouldn’t necessarily argue that biennial mammograms is a bad thing though, and maybe a compromise would be biennial mammograms beginning at age 40. In Europe, it is this way.

My recommendation to you would be to start mammograms at age 40, and plan to get them every year or every other year.

 

Q. Even if a woman holds off on regular mammograms until she’s 50, should she get a baseline mammogram in her 40s?

Dr. DiNome: That’s a difficult question to answer because, if you are starting your screening at age 50, that means you agree with the U.S. Task Force data that it is not efficient to begin screening at age 40. So a baseline at that age would not make sense. There is no doubt that starting annual screening at age 40 reduces death from breast cancer, but the argument is that it is too low of a number to be considered significant. The probability of dying from breast cancer after age 40 is 3 percent. If you screen biennially between ages 50-74, you can reduce that to 2.5 percent. If you start screening annually at age 40, then you reduce it to 2.4 percent, which hardly seems significant when you talk about numbers. It’s just difficult when you equate it with a life because in my mind any life is worth saving.

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Q. I got a mammogram and was told I have dense breasts, which I believe most Asian women have. Should we insist on an ultrasound?

Dr. DiNome: Almost every premenopausal female will have dense breasts because it’s a reflection of the hormonal stimulation on our breast tissue. After menopause, there is significantly less (unless they’re on hormone replacement therapy) and the breast tissue becomes more replaced by fat. The downsides of mammograms are that they are notoriously less sensitive in a woman with dense breasts, and that’s why we don’t recommend beginning screening in a woman under age 40. The ability of the mammogram to show anything helpful in that scenario is so low it’s not worth doing. For women over 40 who have dense breasts, a mammogram should still be performed because it is the only imaging modality that will pick up calcifications reliably, and this can be one of the earliest signs of breast cancer. A screening ultrasound does have some value as an adjunctive screening test to a mammogram, but not in place of. I do think it is worthwhile for women with dense breasts to advocate for a screening ultrasound, but it is not yet a test that is covered by insurance for routine screening.

Q. The risk of breast cancer for Asian American women seems to be rising (compared to women in Asia) — is there anything in particular we should be doing to protect ourselves?

Dr. DiNome: I think this has a lot to do with adopting a western diet. Population studies have demonstrated that if you followed immigrants from Asia to America, that over two generations the risk of cancer increases significantly. Right now, the risk of breast cancer in Asia is five times less than the risk in America. My recommendation would be to adopt a more whole food, plant-based diet and to minimize the amount of animal protein, which we eat way too much of in the U.S. My husband and I went vegan a few years ago for the health effects. I have a strong family history of cancer (not the least of which is my father who died from colon cancer at age 39) and I now have 3 1⁄2-year-old twin girls. Because my husband and I had kids later in life, we feel it’s our responsibility to do whatever we can to ensure that we will be around for them as long as possible. So we did a lot of research and we both independently concluded (my husband before me, mind you) that a vegan diet has the most evidence-based data for a cancer protective diet.


Dr. Maggie DiNome is the current chief of General Surgery at Saint John’s Hospital in Santa Monica, Calif. She is a board certified general surgeon, who focuses her clinical expertise on cancer surgery and advanced laparoscopic techniques. As a fellow of the Society for Surgical Oncology and a member of the American Society of Breast Surgeons, Dr. DiNome is particularly dedicated to caring for patients with breast and colorectal cancer. 

 

This story was originally published in our Fall 2013 issue. Get your copy here