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Why breast density is important

I thought I was doing everything right. I never missed my annual mammogram. I did self-examinations, ate healthy and had no known risk factors for breast cancer. Yet one day I felt a lump. I was not particularly worried. I recently had a “normal” mammogram, which did not detect anything. Then I was sent for a diagnostic mammogram, which also did not detect anything. But an ultrasound the same day revealed the heartbreaking news: I had breast cancer. Why did it not show up on the mammograms? It was then that I was told I had extremely dense breasts and the not-so-small, not-so-early stage cancer was hidden by the dense tissue. I have never been told before that I have dense breasts, never been told that breast density increased my risk for breast cancer, never been told that breast density significantly reduces the effectiveness of a mammogram, and have unfortunately never been told that additional screening tools are available which may have detected my cancer at an earlier stage.

Mammography is more effective at detecting cancer in some women than others. For women with dense breasts, cancer often grows unseen on mammography and therefore additional screening may be necessary.

Key facts:

  • Dense breast tissue is common: 40% of women 40 and older have dense breasts.
  • Breast density is determined by a woman’s mammogram and described as one of four categories, depending on the amount of breast tissue compared to fat in the breast.
  • Cancer is four times more likely to develop in women with extremely dense breasts than in women with greasy breasts.
  • Although mammograms find some cancers not seen on other screening tests, mammograms in dense breasts will miss up to 40% of the cancers present.
  • In dense breasts, other screening tests, such as ultrasound or especially breast MRI, in addition to mammography, significantly increase the detection of early-stage breast cancer.

Why does breast density matter?

Dense breasts increase both the likelihood of developing breast cancer and the risk of that cancer being missed by mammography.

Dense breast tissue appears as white on a mammogram, while fatty tissue is dark gray. Unfortunately, cancers also appear as white on a mammogram. If there is a lot of dense tissue on a mammogram, a cancer can “hide” between the dense tissue. This is true even if the mammogram was done with 3D / tomosynthesis. Searching for cancer in a dense breast has been compared to searching for a snowball in a snowstorm.

In dense breasts, a “normal”, “negative” or “benign” mammogram does not necessarily mean that cancer is not present. No matter how recent your last mammogram, a lump or any changes in your breast should be brought to the attention of your healthcare provider.

In addition to hiding cancer, breast density is also one of many known risk factors for breast cancer. The greater the density of the breast tissue, the greater the risk of developing breast cancer.

How is breast density determined?

When you get your mammogram, your breast density is ranked as one of four categories:

  • Category A – Fat
  • Category B – Distributed areas of fibroglandular density
  • Category C – Heterogeneous you
  • Category D – Extremely dense

Breasts that are Category C – Heterogeneously dense, or Category D – Extremely dense, are considered “dense” breasts.

How do I know if I have dense breasts?

Generally, this information will be provided to you by your healthcare provider, who will have received it from the facility that performed your mammogram. It can also be included in the letter you receive after your mammogram is performed. Many states (38 and the District of Columbia) now have laws that require some information about breast density to be included in the letter women receive after their mammogram. However, the laws differ from state to state. To learn the reporting requirements in your state, please see the legislative card on

Early detection matters, so be an informed self-advocate. All women must know their breast density and individual risk factors, discuss the benefits and risks of additional selection with their healthcare professional, and pursue additional screening if appropriate for them, to ensure the earliest stage diagnosis possible.


Additional resources

Patient Video Series: Let’s Talk About Thick Breasts

About the author:

JoAnn Pushkin is executive director of The site, which is cited as the “most up-to-date and comprehensive resource” on the subject, is the collaborative effort of world-renowned breast imaging experts and medical reviewers.

Pushkin’s initiative and advocacy served as inspiration for New York State’s Breast Density Inform Act. At the federal level, she continues to lead efforts toward a single national “density” reporting standard through both the introduction of the Federal Breast Density and Mammography Reporting Act, as well as the FDA’s regulatory amendment to the Mammography Quality Standards Act.

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