What are ‘dense breasts’ and how do you know if you have them? 

Breast tissue is made up of milk glands, milk ducts, supportive and fatty tissue.  Every woman has different types of breasts, some with more or less fatty tissue and more or less breast densities.  During mammogram screening, dense breasts can be quantified as mild, moderate or severe. This is important since women with severe dense breasts seen on mammogram are at risk for breast cancer. If you have 75% dense breast tissue on mammogram, you are 4 to 6 times at risk for breast cancer.

What is invasive ductal carcinoma breast cancer?

80% of breast cancer is invasive ductal carcinoma which is also known as infiltrating ductal carcinoma and is the most common type of breast cancer. This form of breast cancer comes from the mild ducts and grows into the fatty tissue of the breast.

Is invasive ductal carcinoma breast cancer genetic? 

The only way if invasive breast cancer is genetically related is to get the Br Ca 1 and 2 genetic testing.  30% of breast cancers are related to a genetic association. It is also important to know that 60% of breast cancers occur in women without any known risk factors.

What are typical risk factors for breast cancer?

Risk factors for breast cancer which include:

• Number of first-degree relatives with breast cancer
• Women who had their first menstrual period before age 12
• Women who had their first pregnancy after age 30 or women who have never had a full-term pregnancy.
• Number of previous breast biopsies 
• Women with breast cancer are more likely to develop a second breast cancer.
• Presence of atypical hyperplasia 
• Mammographic breast density
• Excessive alcohol consumption
• BMI> 30
• Physical inactivity

When should I get tested for the BRCA1 and BRCA2 mutations for breast cancer?

Family history is important at identifying those who should be tested for the BRCA1 and BRCA2 mutations. Women who have family members with breast, ovarian, fallopian tube or peritoneal cancers may be at risk for these harmful mutations.  A male family member with breast cancer may put a female family at risk and should be tested as well.

• Breast cancer diagnosed before age 50 years
• Cancer in both breasts
• Both breast and ovarian cancers
• Multiple breast cancers
• Two or more primary types of BRCA1- or BRCA2-related cancers in a single family member
• Cases of male breast cancer
• Ashkenazi Jewish ethnicity

I have Ashkenazi Jewish ethnicity will I be positive for BRCA1 and BRCA2?

Just because you are an Ashkenazi Jew doesn’t mean you need to be tested for the BRCA1 and BRCA2 gene. Only 2% of Ashkenazi Jewish women are more likely to carry the BRCA1 and BRCA2 mutations. 1 in 40 women of Ashkenazi Jewish ancestry have a BRCA1 and BRCA2 placing at risk for developing certain cancers compared to 1 in 800 in the general population.

Does the birth control pill increase my risk of breast cancer?

This is always a concern by women taking the birth control pill for long periods of time. There may be a very small increased risk of breast cancer for those taking the pill but the overall risk is very low and is likely not significant. It’s important to counsel women about any risk factors, including a strong family history of breast cancer, when taking the birth control pill. To put a realistic perspective on this, one doctor made an easy-to-understand comparison, “you have a greater chance of dying during pregnancy than you do from getting breast cancer from hormonal conception.” Women already have a 1 in 8 chance of developing breast cancer in their lifetime.  Other lifestyle risks including obesity, alcohol use, smoking, early start of menstruation, having children later in life or not at all, not breastfeeding and eating a high fat diet increase your risk as well.

My doctor told me I have fibrocystic breasts what does that mean? 

Fibrocystic or dense cystic breasts are tissue that is classically lumpy and tender occurring in both breasts.  Fibrocystic breasts create noticeable changes in the tissue including the ducts and stroma as a result of hormonally and lifestyle influences.  This common benign disease of the breast affects 60% of women and is caused by normal breast cysts.  

Symptoms include breast tenderness and pain especially a week before a period is common symptoms of fibrocystic disease. Fibrocystic breasts are classically lumpy and tender in the upper and outer areas of both breasts.  Varying sizes of fluid filled cysts are more noticeable one week before a period for those women suffering from this condition. Some women don’t experience any symptoms and have fibrocystic breasts only noticed on exam or breast imaging.   Symptoms of fibrocystic breasts typically occur under the age of 50years and go away during menopause.

Fibrocystic breasts are diagnosed by a detailed history, physical exam and age appropriate screening tests including a breast ultrasound. Other ways to diagnosis FCD is fine-needle aspiration and breast biopsy. 

 How can I treat fibrocystic breast disease?

Treatment includes wearing a supportive bra, sometimes even at night, taking Tylenol or Advil and using Vitamin C, E, B6 and A. Oil evening primrose works well too. In severe cases, draining breast cyst or removing them surgical is necessary. 

How can I prevent Fibrocystic breast disease (FCD)?

The cause of fibrocystic breasts is unknown. Over 50% of breast tissue is destined to have fibrocystic changes.  Estrogen driven hormonal changes, oral contraception, caffeine and tobacco will make fibrocystic breast tissue more noticeable and symptomatic. Limiting the amount of caffeine, you drink and stopping cigarette smoking will quickly reduce the symptoms of breast pain and tenderness. Changing the brand of pill, you are taking or the type of contraception used is also a way to improve symptomatic fibrocystic disease.

Why is it important to be aware of this condition and diagnose it? 80

It’s important to know common and hormonal stimulated changes in your breast tissue which can be a usual occurrence. Knowing your normal will help you differentiate what is not normal. Monthly periods can make FCD an expected symptom.