Having dense breasts is linked to cancer. But advice about breast density can depend on where you live
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Having dense breasts is a clear risk factor for breast cancer. It can also make cancers hard to spot on mammograms.
Yet you might not be aware you have dense breasts, even after mammographic screening.
In Australia, advice for women with dense breasts and their health-care professionals can be inconsistent and confusing.
This is because there’s not currently consensus on whether women who have dense breasts, but no symptoms, benefit from further imaging such as ultrasounds. Concerns include potential cost of these tests and the risk they can produce false positives.
What is breast density?
Breasts are made up of fatty tissue and fibroglandular tissue (including glands that make milk, held together by fibrous tissue).
On a mammogram – an x-ray of the breast – fibroglandular tissue appears white and fatty tissue appears dark. The white areas are referred to as breast density.
A higher proportion of fibroglandular tissue means your breasts are dense.
There are four categories to classify breast density:
- A: almost entirely fatty
- B: scattered areas of fibroglandular density
- C: heterogeneously or consistently dense
- D: extremely dense.
Breast density is very common. Around 40% of women aged 40–74 are estimated to have “dense breasts”, meaning they fall in category C or D.
What’s the link to cancer?
Breast density is associated with the risk of breast cancer in two ways.
First, breast density usually decreases with age. But if a woman has high breast density for her age, it increases her likelihood of breast cancer.
One study looked at the risk of breast cancer over the age of 50. It found there was a 6.2% risk for the one-third of women with the lowest density. For the 5% with the highest density, the risk was 14.7%.
Second, breast density “masks” cancers if they develop. Both cancers and breast density appear white on a mammogram, making cancers very hard to see.
Breast cancer screening saves lives through early detection and improved treatment options. But we don’t yet know if telling women about their breast density leads to earlier cancer detection, or lives saved.
In Australia, screening mammography is free for all women* aged 40 and older. This is run through BreastScreen Australia, a joint national, state and territory initiative. Those aged 50-74 are invited to have a mammogram, but it’s available for free without a referral from age 40.
However, the messages Australian women currently receive about breast density – and whether it’s recorded – depends on where they live.
What does the advice say?
In 2023, the Royal Australian and New Zealand College of Radiologists updated its position statement to recommend breast density is recorded during screening and diagnostic tests in Australia and New Zealand.
Meanwhile BreastScreen Australia says it “should not routinely record breast density or provide supplemental testing for women with dense breasts”. However this position statement is from 2020 and is currently under review.
Some state and territory BreastScreen programs, including in Western Australia, South Australia and soon Victoria, notify women if they have dense breasts. Victoria is currently at an early stage of its roll-out.
While the messaging regarding breast density differs by state, none currently recommend further imaging for women with dense breasts without speaking to a doctor about individual risk.
What are the issues?
Providing recommendations for women with dense breasts is difficult.
The European Society of Breast Imaging recommends women with extremely dense breasts aged 50–70 receive an MRI every two to four years, in addition to screening mammography. This is based on a large randomised controlled trial from the Netherlands.
But the Royal Australian and New Zealand College of Radiologists describes this recommendation as “aspirational”, acknowledging cost, staffing and accessibility as challenges.
That is, it is not feasible to provide a supplemental MRI for everyone in the screening population in category D with extremely dense breasts (around 10%).
Further, there is no consensus on appropriate screening recommendations for women in the category C (heterogeneous density).
We need a national approach to breast density reporting in Australia and to do better at identifying who is most likely to benefit from further testing.
BreastScreen Australia is currently undergoing a review of its policy and funding.
One of its goals is to enable a nationally consistent approach to breast screening practices. Hopefully breast density reporting, including funding to support national implementation, will be a priority.
*This includes those recorded female at birth and who are gender diverse.
Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What families should know about whooping cough
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What you need to know
- Whooping cough is a bacterial respiratory illness that can cause long-term symptoms and even death.
- Two types of vaccines protect against it: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults.
- If you or your child has symptoms of whooping cough, isolate them from vulnerable family members and seek treatment early to reduce the risk of serious illness.
Whooping cough, also called pertussis, is a highly contagious respiratory illness that’s particularly dangerous for babies. Cases are now at least four times as high as they were at this time last year. Fortunately, vaccines are extremely effective at preventing the disease across age groups.
Read on to learn about the symptoms and risks of whooping cough, who should get vaccinated, and what to do when symptoms appear.What are the symptoms of whooping cough?
Early symptoms of whooping cough typically appear five to 10 days after exposure and may include a runny or stuffy nose, a low fever, and a mild cough. One to two weeks later, some people may experience extreme coughing fits that can cause shortness of breath, trouble sleeping, vomiting, fatigue, and rib fractures. These fits usually last one to six weeks, but they can last up to 10 weeks after infection.
About one in three babies under 1 year old who contract whooping cough require hospitalization, as they may experience life-threatening pauses in breathing (called apnea), pneumonia, and other complications. Children and adults who have asthma or are immunocompromised are also more likely to develop severe symptoms.
Which vaccines protect against whooping cough, and who is eligible?
Two types of vaccines protect against whooping cough: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults. Both vaccines protect against infections from diptheria, tetanus, and pertussis.
The Centers for Disease Control and Prevention recommends that pregnant people receive a single dose of the Tdap vaccine between 27 and 36 weeks of pregnancy, as this lowers the risk of whooping cough in babies younger than 2 months old by 78 percent.
Multiple doses are required for the best protection. Learn more about DTaP and Tdap vaccine schedules from the CDC, and talk to your health care provider about how many doses you and your children need.
What should families do when whooping cough symptoms appear?
If you or your child has symptoms of whooping cough, isolate the infected person from vulnerable family members. It’s also important to seek treatment early to reduce the risk of serious illness. Health care providers typically prescribe antibiotics to those recovering at home.
Over-the-counter cough and cold medicine is not recommended for children under 4 years old. However, limiting smoke, dust, and chemical fumes at home and using a humidifier can reduce coughing. If you are caring for someone with whooping cough who exhibits pauses in breathing or develops gray or blue skin, call 911 immediately.
For more information, talk to your health care provider.Share This Post
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Fruit, Fiber, & Leafy Greens… On A Low-FODMAP Diet!
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Fiber For FODMAP-Avoiders
First, let’s quickly cover: what are FODMAPs?
FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
In plainer English: they’re carbohydrates that are resistant to digestion.
This is, for most people most of the time, a good thing, for example:
When Is A Fiber Not A Fiber? When It’s A Resistant Starch.
Not for everyone…
However, if you have inflammatory bowel syndrome (IBS), including ulcerative colitis, Crohn’s disease, or similar, then suddenly a lot of common dietary advice gets flipped on its head:
While digestion-resistant carbohydrates making it to the end parts of our digestive tract are good for our bacteria there, in the case of people with IBS or similar, it can be a bit too good for our bacteria there.
Which can mean gas (a natural by-product of bacterial respiration) accumulation, discomfort, water retention (as the pseudo-fiber draws water in and keeps it), and other related symptoms, causing discomfort, and potentially disease such as diarrhea.
Again: for most people this is not so (usually: quite the opposite; resistant starches improve things down there), but for those for whom it’s a thing, it’s a Big Bad Thing™.
Hold the veg? Hold your horses.
A common knee-jerk reaction is “I will avoid fruit and veg, then”.
Superficially, this can work, as many fruit & veg are high in FODMAPs (as are fermented dairy products, by the way).
However, a diet free from fruit and veg is not going to be healthy in any sustainable fashion.
There are, however, options for low-FODMAP fruit & veg, such as:
Fruits: bananas (if not overripe), kiwi, grapefruit, lemons, limes, melons, oranges, passionfruit, strawberries
Vegetables: alfalfa, bell peppers, bok choy, carrots, celery, cucumbers, eggplant, green beans, kale, lettuce, olives, parsnips, potatoes (and sweet potatoes, yams etc), radishes, spinach, squash, tomatoes*, turnips, zucchini
*our stance: botanically it’s a fruit, but culinarily it’s a vegetable.
For more on the science of this, check out:
Strategies for Producing Low FODMAPs Foodstuffs: Challenges and Perspectives ← table 2 is particularly informative when it comes to the above examples, and table 3 will advise about…
Bonus
Grains: oats, quinoa, rice, tapioca
…and wheat if the conditions in table 3 (linked above) are satisfied
(worth mentioning since grains also get a bad press when it comes to IBS, but that’s mostly because of wheat)
See also: Gluten: What’s The Truth?
Enjoy!
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Aspirin vs Cancer Metastasis
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Aspirin is a bit of a mixed bag.
In the category of things in its favor, it’s a modest analgesic with few side effects from occasional use, so it’s a good option if you have a headache, for example.
Unless you’re already on blood thinners or having a bleeding disorder, in which case, aspirin is not the thing to reach for.
About aspirin and heart disease
This is actually a complicated one, and we covered it at length in a dedicated main feature. If you want a one-line summary, it’s “chronic low-dose aspirin use can lower overall CVD risk, but does not reduce CVD mortality or all-cause mortality, and you may pay for it with gastrointestinal bleeding, and increased risk of ulcers“.
For a more nuanced explanation, see: Aspirin, CVD Risk, & Potential Counter-Risks
On the other hand, if you are having a heart attack and are waiting for the ambulance that you already called, and have aspirin to hand that you don’t have to go looking for, then it can be good to take a dose then.
For more on that, see: How To Survive A Heart Attack When You’re Alone
There are more problems
In the case of chronic use of low-dose aspirin, not only does it increase the risks of bleeding, especially gastrointestinal bleeding, and ulcers, but also it increases the risk of anemia. Given that anemia also gives the symptom “dizziness”, this is also a significant threat for increasing the incidence of falls in the older population, too, which can of course lead to serious complications and ultimately death.
For the science about this, see: Low-Dose Aspirin & Anemia
Now, about aspirin and cancer metastasis
This one’s a point in aspirin’s favor.
Cancer is, in and of itself, obviously a big problem. In terms of when it’s most likely to kill someone, that is usually when the cancer becomes metastatic, that is to say, it has spread.
So, while preventing cancer and, failing that, killing cancer are very important goals, there is a third axis to cancer care, which is preventing metastasis in someone who has cancer.
And that’s what aspirin does. How, you ask?
Scientists found this one out by accident!
They were doing genetic research in mice, to find genes that had an effect on metastasis. In the process, they found a certain gene that instructs the creation of a certain protein, and mice that lacked that gene (and thus its associated protein) had less metastasis.
The protein in question suppresses T-cells, which are programmed to recognize and kill metastatic cancer cells (amongst having other great jobs; they are an important part of the immune system in general, and one that declines with aging; most people in their 60s or older are producing very few T-cells).
About that, see: Focusing On Health In Our Sixties
Tracing the cell signaling, the researchers found that the protein is activated when T-cells are exposed to thromboxane A2 (or TXA2 to its friends).
And TXA2? That’s produced by platelets, and aspirin works by inhibiting TXA2 production, effectively making platelets (and thus the blood as a whole) less sticky.
So, that’s quite a few steps in the process, but ultimately:
- Aspirin inhibits TXA2 production
- Lower TXA2 levels mean ARHGEF1 (that’s the protein) isn’t activated
- ARHGEF1 not being activated means T-cells are free to do their thing
- T-cells are now free to kill metastatic cancer cells
You can read the paper here:
Aspirin prevents metastasis by limiting platelet TXA2 suppression of T cell immunity
Take care!
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Rehab Science – by Dr. Tom Walters
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Many books of this kind deal with the injury but not the pain; some source talk about pain but not the injury; this one does both, and more.
Dr. Walters discusses in detail the nature of pain, various different kinds of pain, the factors that influence pain, and, of course, how to overcome pain.
He also takes us on a tour of various different categories of injury, because some require very different treatment than others, and while there are some catch-all “this is good/bad for healing” advices, sometimes what will help with one injury with hinder healing another. So, this information alone would make the book a worthwhile read already.
After this two-part theory-heavy introduction, the largest part of the book is given over to rehab itself, in a practical fashion.
We learn about how to make an appropriate rehab plan, get the material things we need for it (if indeed we need material things), and specific protocols to follow for various different body parts and injuries.
The style is very much that of a textbook, well-formatted and with plenty of illustrations throughout (color is sometimes relevant, so we recommend a print edition over Kindle for this one).
Bottom line: if you have an injury to heal, or even just believe in being prepared, this book is an excellent guide.
Click here to check out Rehab Science, to overcome pain and heal from injury!
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What You Don’t Know Can Kill You
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Knowledge Is Power!
This is Dr. Simran Malhotra. She’s triple board-certified (in lifestyle medicine, internal medicine, and palliative care), and is also a health and wellness coach.
What does she want us to know?
Three things:
Wellness starts with your mindset
Dr. Malhotra shifted her priorities a lot during the initial and perhaps most chaotic phase of the COVID pandemic:
❝My husband, a critical care physician, was consumed in the trenches of caring for COVID patients in the ICU. I found myself knee-deep in virtual meetings with families whose loved ones were dying of severe COVID-related illnesses. Between the two of us, we saw more trauma, suffering, and death, than we could have imagined.
The COVID-19 pandemic opened my eyes to how quickly life can change our plans and reinforced the importance of being mindful of each day. Harnessing the power to make informed decisions is important, but perhaps even more important is focusing on what is in our control and taking action, even if it is the tiniest step in the direction we want to go!❞
~ Dr. Simran Malhotra
We can only make informed decisions if we have good information. That’s one of the reasons we try to share as much information as we can each day at 10almonds! But a lot will always depend on personalized information.
There are one-off (and sometimes potentially life-saving) things like health genomics:
The Real Benefit Of Genetic Testing
…but also smaller things that are informative on an ongoing basis, such as keeping track of your weight, your blood pressure, your hormones, and other metrics. You can even get fancy:
Track Your Blood Sugars For Better Personalized Health
Lifestyle is medicine
It’s often said that “food is medicine”. But also, movement is medicine. Sleep is medicine. In short, your lifestyle is the most powerful medicine that has ever existed.
Lifestyle encompasses very many things, but fortunately, there’s an “80:20 rule” in play that simplifies it a lot because if you take care of the top few things, the rest will tend to look after themselves:
These Top Few Things Make The Biggest Difference To Overall Health
Gratitude is better than fear
If we receive an unfavorable diagnosis (and let’s face it, most diagnoses are unfavorable), it might not seem like something to be grateful for.
But it is, insofar as it allows us to then take action! The information itself is what gives us our best chance of staying safe. And if that’s not possible e.g. in the worst case scenario, a terminal diagnosis, (bearing in mind that one of Dr. Malhotra’s three board certifications is in palliative care, so she sees this a lot), it at least gives us the information that allows us to make the best use of whatever remains to us.
See also: Managing Your Mortality
Which is very important!
…and/but possibly not the cheeriest note on which to end, so when you’ve read that, let’s finish today’s main feature on a happier kind of gratitude:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Want to hear more from Dr. Malhotra?
Showing how serious she is about how our genes do not determine our destiny and knowledge is power, here she talks about her “previvor’s journey”, as she puts it, with regard to why she decided to have preventative cancer surgery in light of discovering her BRCA1 genetic mutation:
Click Here If The Embedded Video Doesn’t Load Automatically
Take care!
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Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like
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At least one in ten people have depression at some point in their lives, with some estimates closer to one in four. It’s one of the worst things for someone’s wellbeing – worse than debt, divorce or diabetes.
One in seven Australians take antidepressants. Psychologists are in high demand. Still, only half of people with depression in high-income countries get treatment.
Our new research shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.
Walk, run, lift, or dance away depression
We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.
We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as cognitive behaviour therapy – one of the gold-standard treatments for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.
Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.
But of these exercises, people were most likely to stick with strength training and yoga.
Antidepressants certainly help some people. And of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing.
Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants.
Join a program and go hard (with support)
Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, such as “some physical activity is better than doing none.”
But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.
We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.
Yes, it’s hard to keep motivated
We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.
Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.
We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.
Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.
Other reviews found it’s important to have a clear action plan (for example, putting exercise in your calendar) and to track your progress (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.
A 2021 mega-study of more than 60,000 gym-goers found experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.
Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.
So, when starting out, it seems wise to avoid going it alone. Instead:
- join a fitness group or yoga studio
get a trainer or an exercise physiologist
- ask a friend or family member to go for a walk with you.
Taking a few steps towards getting that support makes it more likely you’ll keep exercising.
Let’s make this official
Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only conditionally recommends exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.
Based on our research, this recommendation is withholding a potent treatment from many people who need it.
In contrast, The Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at least two to three times a week for all people with depression.
Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.
I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Michael Noetel, Senior Lecturer in Psychology, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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