Doctor's Notes, By BRIDGET O’BRIEN
As a breast surgeon, some of the most common patient questions I hear revolve around breast cancer screening—what dense breast tissue means for their health and what treatment might look like if cancer is detected. These are important questions, and understanding the latest recommendations and options can help patients feel more informed and in control of their care.
Early screenings matter
Early detection remains our most powerful tool in fighting breast cancer. Mammography screening has been proven to reduce breast cancer mortality by detecting cancers when they’re smaller and more treatable. For most, I recommend beginning annual mammograms at age 40, though this timeline may shift based on individual risk factors and family history.
If you have a strong family history of breast or ovarian cancer, particularly in first-degree relatives, talk with your doctor about whether earlier or more frequent screening is appropriate. Some women may benefit from genetic counseling and testing to assess their inherited risk.
Dense breast tissue
Many women receive notification that they have dense breast tissue after their mammogram, which can be confusing and concerning. Breast density refers to the ratio of fibrous and glandular tissue to fatty tissue in your breasts. Dense breasts have more fibrous, glandular tissue and less fatty tissue. This is extremely common, as approximately 40 to 50 percent of women have dense breast tissue. With age, breast density often decreases. Dense breast tissue matters for two main reasons.
First, it can make mammograms harder to read because both dense tissue and tumors appear white on mammography, which may mask potential cancers. Second, women with dense breasts have a modestly increased risk of developing breast cancer compared to women with mostly fatty breasts. If you have dense breasts, don’t panic, but do have a conversation with your healthcare provider.
Understanding personal risk
Beyond breast density, several factors influence your risk of getting breast cancer. Breast cancer risk increases with age, family history, certain genetic mutations, menopause after age 55, reproductive history and lifestyle factors. Have an honest conversation with your healthcare provider about your individual risk factors and screening recommendations tailored to you. Screening isn’t a one-size-fits-all strategy. Women with elevated risk may benefit from enhanced screening protocols, including breast MRI, or risk-reduction strategies. Depending on your risk, high-risk imaging may be indicated as young as age 25.
Less can be more
While prevention and early detection remain crucial, we’re also making remarkable progress in how we treat breast cancer when it is diagnosed. The field is moving toward more personalized, less invasive approaches that maintain excellent outcomes while minimizing the physical and emotional impact of treatment.
Lymph node surgery evolution
Historically, when breast cancer was diagnosed, we performed an extensive lymph node removal, which could lead to complications such as lymphedema, or chronic swelling of the arm. A few decades ago, guidelines transitioned to a less invasive surgical technique called Sentinel Lymph Node Biopsy, allowing surgeons to remove a few lymph nodes (where cancer is likely to spread), decreasing lymphedema rates. More recently, research shows that for carefully selected patients, we may be able to safely avoid removing any lymph nodes without compromising survival.
For women with breast cancer already spread to the lymph nodes, the less invasive Sentinel Lymph Node Biopsy may be available after completing chemotherapy if there has been an appropriate response to chemotherapy. This significant shift reduces surgical complications while maintaining excellent cancer control.
Rethinking DCIS treatment
Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer where abnormal cells are confined to the milk ducts. We’ve learned that not all DCIS behaves the same way—some types are more aggressive, while others grow very slowly or may never progress to invasive cancer.
Preliminary clinical trials have demonstrated select patients with low-risk DCIS may qualify to be safely monitored with close surveillance, and possibly medication treatment, rather than automatically proceeding to surgery. Clinical trials will continue to gather long-term data to further identify which patients might benefit from this approach.
The path forward
Medicine is constantly evolving, and breast cancer care is no exception. We’re moving toward an era of increasingly personalized treatment—matching each patient with the screening and treatment strategy that’s right for their specific situation.
My advice? Stay informed, maintain regular screening appropriate for your risk level, and don’t hesitate to ask questions and be your own advocate. If you have concerns about your breast health, screening recommendations or what your mammogram results mean, reach out to your healthcare provider. We’re here to partner with you in protecting your health and, when needed, providing the most advanced, individualized care available.
Dr. Bridget O’Brien is a Breast Surgical Oncologist and is a board-certified surgeon with Texas Oncology and St. David’s Georgetown Hospital. She specializes in the surgical treatment of breast diseases and is committed to providing compassionate, evidence-based care to her patients.