By Adriana Ermter
In our monthly column, senior writer and editor Adriana Ermter shares her personal experiences with breast cancer
This is what I used to think about my boobs before I was diagnosed with breast cancer: Perky. Full B-cups. Still look good without a bra.
Pretty good descriptors, right? That’s because back then I liked my boobs. I had a happy, take-them-at-face-value relationship with them and it worked. Or at least I thought it did until I was diagnosed with breast cancer. Now, I know about and worry about all kinds of breast cancer-related things. Like, the fact that I have dense breasts.
Why dense breasts are a big deal
Because they increase your risk of breast cancer. Period. Dense breast tissue can mask tumours on mammograms, making the cancer harder to see and easier to miss. Having dense breasts can also increase the likelihood of interval cancers—which are cancers diagnosed between regular screening exams—and these cancers are often more aggressive when they are diagnosed at a later stage.
While I arrived at the breast cancer clinic with an existing lump, I wasn’t diagnosed right away. Maybe it was because my tumour was in my right armpit or perhaps because I’d found it myself. It’s hard, round, pea shape was easy to feel through my skin and multiple physicians came in for a look and feel. Yet, none of the doctors during that first appointment took my tumour seriously. They said I was too young to have cancer. I didn’t have a familial history. I didn’t have the BRCA I or II genes. What I did have that day was my first-ever mammogram, right before I was turned away and told I had nothing to worry about.
Not so; I worried for six months, calling the clinic every 30 days to politely request a second screening. It worked. I was granted another mammogram. Yet after the procedure, as the medical team tried to shoo me back into the change room, I reminded them that my lump was in my armpit, where the mammogram couldn’t reach, and it had grown since my last visit. That was when I learned I have dense breasts. One of the doctors who’d been examining me mentioned it to one of their students (it was a learning hospital) and because I was laying right there and heard them, I interrupted, asking: “What are dense breasts?”
Dense breasts explained
Dense breasts refers to the density of the tissue inside your breasts. It’s not something you can feel by touching them and it has nothing to do with size, firmness or how they look.
Breast density is a measurement of your breasts’ fibrous and glandular tissue—often referred to as fibroglandular density—in comparison to its fatty tissue. These tissues can only be seen on a mammogram. Dense breast tissue appears white, the same colour as a tumour, which is why it makes cancer harder to spot. Fatty breast tissue appears dark on a mammogram, making abnormalities like cancer easier to detect. When radiologists review the breast imaging from a mammogram, ultrasound and/or MRI, they use a standardized framework called the Breast Imaging-Reporting and Data System (BI-RADS) to report their findings, which include your breast density.
Much like bra cup sizes, breast density is measured in categories which, as noted by Cancer Care Ontario, are labelled A, B, C or D. Category A is when the breasts are almost entirely made up of fatty tissue. Category B indicates scattered areas of fibroglandular density. Category C means you have heterogeneously dense breasts—a mix of dense and fatty tissue with the dense tissue making up a significant portion, but not the entire breast. Category D refers to extremely dense breasts when the majority of the breast tissue is dense.
Who’s at risk
A lot of women. Having dense breasts is super common, particularly for women in their 20s and 30s, when breasts are naturally denser as density can decrease with age and menopause. Dense Breasts Canada affirms this, attributing 56 per cent of women in their 40s with dense breasts, compared with 37% in their 50s and 27% of women in their 60s. The Breast Cancer Research Foundation adds that approximately 40% of all women will fall into Category C and roughly 10% will fit Category D.
Category D women also have a four to six-times higher risk of developing breast cancer compared to women with mostly fatty breasts. For women with dense breasts, mammography alone may not be enough. Supplemental screening such as breast ultrasound and/or breast MRI can detect cancers that mammograms miss. I had both, which proved beneficial as it highlighted not only the tumour in my armpit, but also the tumour’s tail which stretched across my armpit and into my breast.
While ultrasounds and MRIs are not routinely used for population-wide screening because they can lead to more false-positive results, additional testing, and unnecessary biopsies, they may be used as supplemental screening tools for people with dense breasts. Ultrasounds can differentiate between solid masses and fluid-filled cysts. MRIs are the most sensitive screening tool but require intravenous contrast, are more costly, and less widely available. They are often recommended for high-risk women including those who also have additional risk factors, such as a family history of breast cancer or a known genetic mutation.
Your best approach
Be screened and informed, which starts with having a routine mammogram. So, request one. Immediately after you’ve been tested, ask your doctor if you have dense breasts, what category of density you fall into, how that density may affect your personal breast cancer risk and whether additional screening beyond mammography is appropriate for you. You can also ask how often you should be screened, which type of imaging is best for you (mammogram, ultrasound and/or MRI) on an annual basis and whether you should plan for any screening updates or changes as you age. CBCN’s 10 Questions to Ask Your Health Care Team checklist can help guide these conversations and ensure you are asking the right questions about your risk and screening options. Know there is no one-size-fits-all approach.
In some provinces, women are notified directly if they have dense breasts. In others, this information may only be shared by a primary care provider. This means that many women, like me, may never know their breast density until they ask.
Most importantly, remember: having dense breasts is very normal. They are not a diagnosis. They are a risk factor. And like all risk factors, they deserve transparency, conversation and action. Knowing your breast density does not mean living in fear. It means being equipped. It means asking better questions. It means advocating for screening that sees you clearly. Because once you know, you can no longer unknow. And when it comes to your breast health, knowledge is not anxiety. It is power.
Adriana Ermter is a multi award-winning writer and editor. Her work can be read in IN Magazine, 29Secrets.com, RethinkBreastCancer.ca and AmongMen.com. The former Beauty Director for FASHION and Editor-in-Chief for Salon and Childview magazines lives in Toronto with her two very spoiled rescue cats, Murphy and Olive. You can follow Adriana on Instagram @AdrianaErmter
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