Thursday , October 22 2020

Q&A with Radiologist Dr. Amanda Aulls

Does Breast Density Change Your Risk for  Breast Cancer?

Dr. Amanda Aulls
Dr. Amanda Aulls
In an interview, we discussed the concept of breast density with diagnostic radiologist Amanda Aulls. Dr. Aulls suggests that if you find out you have dense breasts, you should discuss potential next steps with your doctor. Each individual woman’s risk for breast cancer is different, and many factors – such as family history and lifestyle – must be taken into account when determining whether additional forms of breast cancer screening are necessary.
What are dense breasts?
Breast density isn’t something you can feel, and firm breasts don’t necessarily mean dense breast.  Density is only seen on mammogram.  Breasts are made up of fatty tissue and glandular tissue.  The more glandular tissue that is present, the denser breast tissue is said to be.
How common are dense breasts?
Dense breasts are very common, and are not considered abnormal.
How does a woman know she has
dense breasts?
Women are unlikely to know if they have dense breasts or not, unless their doctor has told them. Density is only seen on mammogram.  Breast density isn’t something you can feel, and firm breasts don’t necessarily mean dense breast.
What should women who are told they have dense breasts do?
On mammogram, the glandular tissue shows up as white, but unfortunately, breast cancer also shows up as white.  With more glandular tissue, a cancer can be hidden within the tissue since both show up as “white” areas on the mammogram.  For that reason, radiologists will sometimes recommend additional screening exams, such as an ultrasound or less commonly an MRI, based on the patient’s risk factors and mammogram appearance.
Should women who do not have dense breasts make any changes to their regular screenings?
Hidden or obscured cancers are less of a problem in women with predominately fatty breast tissue.  While additional tests such as ultrasound or MRI are sometimes needed if there is new finding or problem, additional yearly screening tests are rarely needed.
Does dense breast tissue merely make it more difficult to detect cancer, or does dense tissue actually increase breast cancer risk?
Dense breast can make detecting a breast cancer more challenging on mammogram.  There is conflicting evidence as to whether or not dense breast tissue increases a women’s risk of getting breast cancer.  However, the increased risk, if real, is small.
Are there any tests that are better than mammography for women with dense breasts?
The gold standard is still yearly mammograms.  Some women may benefit from an additional yearly ultrasound.  For women with a significant family history of breast cancer or the BRCA1/BRCA2 gene, yearly breast MRI is recommended.
Could some of the increased breast cancer risk be caused by the need for a higher radiation dose during screening mammograms in order to penetrate dense tissue? Or could the higher risk be due to the fact that dense breasts simply have more breast tissue that can be exposed to radiation?
Mammograms do involve radiation in order to obtain the images.  Any increased radiation for women with dense breast is minimal.  The estimated risk that radiation could potentially cause a cancer to the breast is <0.1%.  When compared to a  woman’s 12% lifetime risk of developing breast cancer, the risk of radiation is extremely small.  And mammograms allow us to detect breast cancer early, before it has spread to the lymph nodes.  If you can treat breast cancer before it has spread, then the 5 year survival rate is >98%.
Does breast density change from one year to the next? Does it generally stay the same after menopause and throughout one’s lifetime? What might cause breast density to change?
In general, breast density decreases as we age, especially after menopause.  But for some women, their breasts remain dense their entire life.  It varies from person to person.
As with any cancer, earlier detection results in better treatment options and higher success and survival rates. Recommended screening guidelines for all women:
• Women should know how their breasts normally look and feel and report any breast changes to a health care provider right away. Breast self-exam (BSE) is an option for women starting in their 20s.
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health
If you have any questions or concerns about your risk for developing breast cancer and the types of screening available, the team at Radiology Associates is happy to speak with you. Call 352-671-4300 for a consultation or to schedule your screening today!
Dr. Amanda Aulls
Dr. Amanda Aulls provides radiology services at Radiology Associates of Ocala’s Women’s Imaging Center and TimberRidge Imaging Center. She is passionate about saving lives using state of the art detection screening technologies. Born and raised in Eustis, Florida, Dr. Aulls graduated with honors from the University of Florida with a B.S. in zoology. She earned her medical degree from the University of Florida College of Medicine and completed her radiology residency at Shands at UF, where she also garnered a fellowship in neuroradiology.
Immediately after completing her residency, she moved with her family to St. Petersburg, where she served as a general radiologist and as the lead radiologist at the Bayfront Medical Center Breast Health Center. She has spent the last four years with a special interest in Women’s Imaging.
Radiology Associates of Ocala, PA
(352) 671-4300
www.RAOcala.com

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