Published on July 19, 2021

You’ve been told you have dense breasts. Now what?

By Jennifer McAlister, M.D., FACS, Breast Surgeon

Pardee Breast Surgery

For many women who have had regular mammograms, they may have been told by their doctor that they have dense breasts. Many people are unclear what this means and what they should do with this information. In my role as a breast surgery specialist, I am familiar with what it means to have dense breasts and how that can impact your health and your risk of cancer. I would like to offer some answers to some of the questions that I am routinely asked.

What is dense breast tissue?

The breasts are made up of fibroglandular tissue and fat, which give the breasts their size and shape. If your breasts contain more fibroglandular tissue than fat, you likely have dense breasts. Having dense breasts is actually quite common; approximately 40% of women have dense breast tissue.

You can’t tell if your breasts are dense based on how they look or feel; only a mammogram, an x-ray of the breast, can determine if you have dense breast tissue.

When a radiologist – a doctor who reads X-rays – looks at your mammogram, not only will they look for any abnormal or suspicious areas in the breasts, but they will also classify your breast density. The radiologist will determine which of four categories best describes your breast composition: almost entirely fatty tissue, scattered fibroglandular tissue, heterogeneously dense tissue and extremely dense tissue.

Women in the first two categories are considered to have low-density breasts. Women in the second two categories are considered to have dense breast tissue. Typically, breasts become less dense with age, though this isn’t true for all women.

Does dense breast tissue increase the risk of cancer?

Women with dense breast tissue have a 4-6 times greater risk of developing breast cancer than women with fattier breast tissue.

Not only do dense breasts increase your risk for developing breast cancer they can also make it more challenging to identify cancers on a mammogram. The reason for this is that both dense breast tissue and breast cancers typically appear white on mammogram images. Differentiating one from the other can be quite difficult, like finding a cloud in a cloud filled sky. Alternatively, in fatty tissue, which is usually black, a white abnormality can be easily identified.

Screening options for dense breasts

While traditional mammography is still the golden standard for breast imaging, there are additional recommendations for women with dense breast tissue. 3D mammography is FDA-approved and greatly improves mammogram accuracy. In fact, 3D technology has been shown to detect 41% more invasive breast cancers and reduce false positives by up to 40%. This means women experience fewer false-positives and better accuracy – and therefore, less anxiety. It can also detect breast cancer earlier, when it’s more treatable, helping some women avoid chemotherapy.

Fortunately, in addition to 3D mammography, Pardee is able to offer a newer technology called ABUS, Automated Breast Ultrasound. 3D mammograms in conjunction with ABUS have been shown to improve breast cancer detection in women with dense breasts by more than 35.7% compared to mammography alone. ABUS uses 3D ultrasound technology to take images of dense breast tissue. Most screenings last about 15 minutes.

It is essential for women to have regular screening mammograms whether or not they have dense breast tissue. I recommend that all women age 40 and over have annual, screening mammograms. Talk to your primary care provider or gynecologist about your specific breast health, risk for breast cancer and schedule the breast imaging that is right for you.

To learn more about breast health services at Pardee, visit

Dr. McAlister is a fellowship-trained breast surgeon. She sees patients at Pardee Breast Surgery.

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