BY RITA COLORITO
FOR THE PAST 16 years, Wendi Friedman
Tush has had a routine ultrasound after
her annual mammogram screening. The
reason: She has dense breasts. Six years
ago, it was the ultrasound, not the mammogram, that detected breast cancer. “It
may have saved my life,” says Friedman
Tush, a 54-year-old breast cancer survivor
from New York City.
For women with dense breasts, an
annual mammogram screening may not
be enough to detect breast cancer. In dense
breasts, defined as heterogeneously dense
or extremely dense, there’s more connective tissue than fatty tissue, which may
make tumors difficult to see on a traditional mammogram.
Breast density is considered one of the
strongest breast cancer risk factors, says
Gretchen Gierach, senior investigator at
the National Cancer Institute, whose
research focuses on mammographic density. “Over 41 years of epidemiologic
research and numerous studies have demonstrated a strong association between
having a higher mammographic density
and subsequent development of breast
cancer,” she notes.
Forty percent of women age 40 and
older have dense breasts, according to the
educational website densebreast-info.org.
Breast density can be influenced by a
variety of factors, such as age (density
decreases for most women during menopause), childbirth (with each birth, density is thought to be reduced by about 1 to 2
percent), breastfeeding (may reduce density) and tamoxifen, which has been
shown to reduce breast density in breast
cancer patients and women at high risk.
On the other hand, menopausal hormone
replacement therapy (HRT) can cause an
increase in breast density.
Radiologists assess breast density and
include it in their mammogram reports,
but not every woman gets this informa-
tion. In response, 31 states have passed
mandatory breast density notification
laws, but not all require informing patients
of their actual breast density. Densebreast-
info.org features an interactive map of
reporting guidelines by state.
The type of annual mammogram may
make a difference. Digital mammography,
also known as 3-D or tomosynthesis, is
more effective than 2-D mammography at
detecting suspicious masses in heterogeneously dense breasts, but may still miss
cancer in extremely dense breasts.
Friedman Tush’s radiologist added
routine ultrasound screenings to
Friedman Tush’s regular mammograms
based on her overall breast health history.
“In women with extremely dense
breasts, ultrasounds should be considered
in addition to mammography. In women
with heterogeneously dense breasts, we
are still evaluating whether ultrasound is
beneficial after 3-D mammography,” says
Dr. Wendie Berg, professor of radiology at
the University of Pittsburgh School of
Medicine, and co-founder and scientific
adviser of densebreast-info.org. “Women
at high risk should have a supplemental
MRI when possible, regardless of their
breast density.” High-risk factors include a
first-degree family history of breast cancer before age 40 or certain gene mutations, such as BRCA1 and - 2.
“Information is power. Read your
mammogram report,” says Dr. Parvin
Peddi, a medical oncologist at the UCLA
Medical Center. “If you have dense
breasts, talk to your doctor. More screening isn’t for everyone, so that’s why it’s
important to talk about it and go over your
other risk factors.” C
Rita Colorito ( ritacolorito.com) covers a
variety of health issues.
SUICIDE IN the U.S. has surged to the
highest levels in nearly 30 years, according to a New York Times review of a federal analysis of suicide deaths between
1999 and 2014. The study showed
increases in all age groups except older
adults. The rise was particularly steep
for women and was also substantial
among middle-aged Americans, a group
whose suicide rates had been stable or
falling since the 1950s.
The major cause of suicide is mental
illness, most frequently depression. In
contrast with ordinary unhappiness,
depression brings feelings of despondency that are longer and deeper, to the
point of being life-threatening. Those
suffering from depression have a 25
times greater risk of suicide than the
Depression can be treated successfully. It starts with a doctor visit to rule
out medical causes for the condition.
Psychotherapy and/or medications will
be the likely treatments.
What does depression look like?
Knowing the symptoms of depression
is the key to suicide prevention. Look for
• Trouble falling or staying asleep, or
sleeping too much.
• Poor appetite, or overeating.
• Frequently feeling sad, anxious,
guilty, worthless or hopeless.
• Loss of interest or motivation in
activities once enjoyed; trouble concentrating on activities.
• Moving or talking slower.
• More fidgety and restless.
• Thoughts or mentions of suicide.
How you might help
• Be a good listener. Offer emotional
support, understanding, patience and
• Never ignore comments about
suicide; report them to the person’s
close relative or doctor, or call the
National Suicide Prevention Lifeline at
For more information about depres-
sion and other forms of mental illness,
search these websites:
• National Institute for Mental
• National Alliance on Mental Illness,
FOR YOUR HEALTH
Cancer screening for