Saturday, December 16, 2023

PATHOLOGICAL VIEWS OF DENSE BREAST TISSUE

Written by: Dr. Robert L. Bard  (12/2023)
Edited by: Carmen Regallo-Dewitt

Decades since the advent of breast scanning technology, innovations in non-invasive diagnostic imaging provide new options in the field of early detection.  A mammogram can show how dense your breasts are including how low or high in density. However, over-compression artificially lowers the radiographic density.



 [Image 1] in this standard mammogram, a dense breast is presented side by side. The white shaped “V” that comes down the top center are the pectoral muscles of the chest wall. On the far outside, the white line is the skin outline of the breast. This is the dermal tissue causing the white line viewed enface.  Radiologists always study this for any indication of inflammatory disease of the skin or inflammatory breast cancer, which manifests itself in skin thickening.  Between the center wedge and the skin outline, you will find homogeneous cloudy areas with patchy black spaces within as an example of dense breast tissue. 

Usually, dense breast tissue appears white on a mammogram. We must identify them as one of two forms of breast density; one is called FIBROCYSTIC or fibrous [Image 2] which is homogeneously white. Occasionally you can see a branching of blood vessels, dilated ducts or a streak of fat inside the dense breast tissue. This is the most common type of dense breast tissue and generally seen in the over 40 population.

[Image 3] Another example of a dense breast shows the difference between homogeneous white versus the whitish area. This is filled with dark, wormy looking structures, which are the breast glands called GLANDULAR tissue. This kind secretes milk and its glands are often dilated. Both Fibrous and Glandular may appear similar under a mammogram as highly dense areas, but they look completely different under an ultrasound scan.  

Through ultrasound, we can check for tumors easily through fibrotic dense breasts because it stands out as a black region (or a black hole) within the white area. As shown in Image 3, a black hole could get lost, making it more difficult to image this type of dense breast.  In this case, a solution is the use of elastography [Image 4], which offers visual confirmation as indicated by color data. Elastography can measure tissue density (its hardness or elasticity) within the glandular breast tissue. 

This tissue type is more common in the under-40 age group and is associated with other glandular proliferation such as endometriosis and is reportedly linked to dermal inflammation. In published reports, comparative studies between FIBROUS and GLANDULAR breast tissue studies remain limited.  We are observing (especially in the younger age groups) expanding reviews of these types of tissue density aligned with the rates of breast cancer to confirm the rate of malignancy in tissue alteration from normal.





TRIBUTE TO A GLOBAL CRUSADER
(Play Video-L) The NY Cancer Resource Alliance gives loving tribute to Dr. Nancy Cappello, co-founder of "Are You Dense" and chief crusader of the mission to bring change to the protocols and standards of Early Detection.   Her organization embarked in a global advocacy project to win legislation for dense breast scanning and to bring awareness to the need for better technologies and imaging interpretation. Today, her loving husband Joe continues her unending fight to save more lives through awareness, advocacy and her crusade for change.  (Also see below to read her full story in our ORG SPOTLIGHT section)



Epigenetic Research Notes: Profiling the Dense Breast Paradigm (part 1)

 Coursework (Part 1) written by: Dr. Roberta Kline


As an Ob-Gyn physician and genomics specialist, I have spent the better part of 10 years translating research in the genomic and gene expression areas into clinically usable information for healthcare professionals. One of the biggest challenges we face when connecting research with patient care is the long delay in the translation process and dissemination of the information. It often takes 10 to 20 years for information (validated findings) that comes out of research to be applied in clinical practice. These delays result in many lost opportunities to provide better care for our patients. This is one of the reasons why I'm really passionate about accelerating this process and making it easier for clinicians and their patients to take advantage of cutting-edge information and new technologies. 

LINKING DENSE BREAST WITH BREAST CANCER

We have known for a very long time that there is an increased risk of breast cancer for women who have dense breasts. Until recently, the research has been lagging in terms of what's the molecular mechanism, why do dense breasts present an increased risk of breast cancer? Without this knowledge, we can’t address the root causes, and are left with a lot of trial and error based on incomplete understanding.  (see complete report)



LIVING WITH ENDOMETRIOSIS:
From an interview with MJ Smith

My personal and professional missions are both in women's health. By day, I work for a breast AI company focused on helping radiologists find breast cancers on mammograms. I chose this path because I believe in advancing causes that support women's health simply because women are core members of our culture and our families. I have had two family members, both maternal aunts, who died of breast cancer, - one at the age of 36, and an the other at the age of 52.

Advocacy for Endometriosis is directly related to my personal journey. Growing up with endometriosis since puberty, I've been to the emergency department probably over 20 times for pain or pelvic pain related conditions. The pain had me flat on my back for days at a time or falling out of bed with pain.  I drove myself to a Planned Parenthood in Minnesota where I grew up and was prescribed birth control to manage it well into my twenties.  Despite the hormonal treatments, I still had a series of episodes. 

Endometriosis is the uterine tissue that grows and implants itself outside of the uterus. Going through that pain is the result of a complex process, resulting in swelling and bleeding inside the interstitial spaces of my body. Women who have endometriosis also often develop painful cysts on their ovaries. 

I think the biggest reason you see women in the ER is pelvic pain. Women with chronic pelvic pain (which is often what endometriosis causes) are underserved by the healthcare community because we're constantly complaining of pelvic pain.  The ER is not where you want treatment because you see a different doctor every time you get admitted. With emergency imaging, you usually get a pelvic ultrasound where cysts can show up and they're quick to assume that you have a cyst, or a cyst has burst and this is why you're uncomfortable.  I think now you can do a pelvic MRI with contrast media- but it's still not enough to offer a definitive diagnosis.  (See complete report)





Decades since the advent of breast scanning technology, innovations in non-invasive diagnostic imaging provide new options in the field of early detection. These technologies directly align with breast density screening (and are part of the Bard Breast Density Diagnostic Program).








CONTRIBUTORS

ROBERT L. BARD, MD  (Diagnostic Imaging Specialist)
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. His most recent program is dedicated to the reporting of mental health diagnostic and innovative solutions including the use of modern neuromagnetic technologies and protocols in his MEDTECH REVIEWS program. 



ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group)
Dr. Kline is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://bobbiklinemd.com 






Copyright © 2023- Robert L. Bard, MD & cancerscan.com. All rights reserved.


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