Unlike in the US, women in India are not told if they have dense breasts. This could mean a missed cancer diagnosis.
“If we just do that check every now and again to see if there are changes, it can be the difference between stage 1 and stage 4.”
Dense breasts are more common than we think. According to the US National Cancer Institute, nearly half of women aged 40 and above are found to have dense breast tissue in mammograms. Breast density is directly linked to an increased cancer risk, which is why the US FDA has mandated mammogram reports to include breast density details since last year.
Enhanced cancer screening for women with very dense breasts could detect 3,500 additional breast cases annually, potentially saving 700 lives.
But in India, where breast cancer is the most common cancer among women, there’s a shocking lack of knowledge about dense breasts and no disclosure mandates at all. “In the West, women are routinely informed about their breast, density and advised supplemental screening. But it’s not yet standard practice in India. So, many women assume a ‘normal’ mammogram means they’re in the clear, whereas additional imaging could reveal a hidden tumor.
WHAT IS BREAST DENSITY?:
It’s not something one can identify through appearance or physical examination. “It can only be assessed through a mammogram and ranges from almost entirely fatty (Category A) to extremely dense (Category D).” Categories C”CED (heterogeneously dense) and D are considered dense breasts. “These are the cases where mammograms may miss early tumors, making additional screening crucial. Dense breasts are not just harder to image, they’re biologically more active. Women with extremely dense breasts have a 1.5 to 2 times higher risk of breast cancer than those with fatty breasts.”
“CEDM is proving very useful in practice.” For dense breasts, we always need extra tests — like ultrasound, CEDM, or MRI — so we don’t miss hidden cancers.”
HARDER TO SPOT CANCER:
Dense breasts have more fibroglandular tissue (connective and glandular tissue, including milk ducts). Both dense tissue and malignancies appear white on a mammogram. So, looking for a tumor in dense breasts is like spotting a snowball in a snowstorm.” This “camouflage effect” can lead to false negatives, delaying diagnosis by months or even years. Breast cancer begins when a single cell in the breast undergoes a mutation. “If you have 10 cells, your odds of cancer are 1 in 10. But if you have 100, the chances rises. Women with dense breasts face a higher risk simply because of increased cell population.”
WHAT MAKES BREAST TISSUE DENSE?:
Breasts have glandular cells that produce milk and hormonal stimulation till a certain age makes them multiply. So, younger, premenopausal women have more dense breast tissue than fatty tissue (transparent to radiation, appears as black in imaging). “In older women, especially those above 50, breasts have less density. So, mammograms diagnose cancers in them more effectively.”
Oestrogen plays a key role in making breasts dense. But postmenopausal women — on hormone replacement therapy (HRT) or with high endogenous oestrogen — often retain or regain breast tissue. “Early menarche, late menopause, nulliparity (not giving birth), and HRT are linked to more density, as are low BMI and high alcohol intake.”
Women with a first-degree relative with breast cancer or dense breasts are more likely to have dense tissue. Among Indian women who undergo mammography, 25% to 30% fall under categories C or D. “This means at least 1 in 4 women has dense breasts.”
RAISE AWARENESS, SAVE LIVES:
Should India impose rules on breast density disclosure for every mammography just like the US? “Unquestionably, yes”. That would improve transparency in diagnosis, empower patients and encourage timely supplemental imaging.” But developing nations can’t always follow protocols set by developed nations.
“Our priority must be to raise awareness. Every woman undergoing a mammogram should be educated about dense breasts and the possibility of a missed diagnosis.” Government initiatives to subsidize ultrasound or MRI for women with dense breasts to ensure early detection and timely treatment.
HIDDEN DENSITY:
- Over 50% of Indian breast cancer cases present at Stage 3 or 4, largely due to late detection.
- 22% of Indian women aged 40-49 have dense breasts.
- This decreases to 9% in women in the 50s.
- And to 8% in women in their 60s and 70s.
