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Breast density— the cancer risk factor millions of women may not know about
Data suggests millions of women in the UK aren’t being told their breast density, despite it being a risk factor for cancer.
New research, published during Breast Cancer Awareness Month, has revealed a stark lack of awareness around breast density among UK women.
Just under half (40 per cent) of women over the age of 40 have dense breasts —breasts with more fibrous or glandular tissue and less fat—with Asian women more likely to have dense breasts than women of other ethnicities.
While it is normal for breast density to vary from woman to woman, studies have shown that those with extremely dense breasts are four to six times more likely to get breast cancer than a woman with fatty breast density.
It is also understood that having dense breasts makes it harder to detect breast cancer through mammography, the standard screening method worldwide.
Breast cancer is the most common form of cancer in women globally, affecting around two million women every year, with over 56,000 new cases in the UK alone. Early diagnosis is key, with over 90 per cent of women surviving for five years or more, when it is diagnosed in the early stages.
But the new research, conducted by Bristol-based health tech company, Micrima, found that 86% of women in the UK (around 23.8 million) don’t know their breast density. In fact, they are six times more likely to know their childhood phone number.
The survey, conducted in partnership with Opinium, also revealed that two thirds (67 per cent) of women are unaware that having dense breasts makes it harder to screen for breast cancer using standard methods, with one in 20 (five per cent ) thinking it makes it easier, and one in six (16 per cent) believing it makes no difference.
Based on this, Micrima estimates that as many as four million women over the age of 40 in the UK have dense breasts and don’t know they are at greater risk of developing cancer.
“I had no idea I had dense breasts”
Clare Cowhig was one of those women. She was diagnosed with invasive ductal cancer in both breasts in 2018 at the age of 50.
Despite having a clear mammogram nine months previous, she booked a private ultrasound after becoming concerned about an unusual area on her breast.
Clare was told by the sonographer that she had “the densest breasts they had ever seen” and was questioned about why she hadn’t been having MRIs due to the reduced sensitivity of mammography to find tumours in dense breasts.
“Despite my significant family history of breast cancer, and having had mammograms annually since I was 41, I had no idea I had dense breasts, or why that was significant,” says Clare.
Clare believes her cancer could have been detected sooner.
“Unfortunately, after further investigation, it was confirmed I had an invasive ductal cancer in each breast. I had highly dense breasts and these tumours never showed up on my mammograms. One tumour was stage-three and over five centimetres, the other was stage two and two centimetres. I had further areas of ‘in-situ’ disease in both.”
Following the sonographer’s comments, Clare requested her hospital records and discovered that her dense breast tissue had been noted after each of her annual mammograms, yet the information was never shared with her. Now she believes that had she been aware of this, the cancer may have been detected sooner.
“If I had been told about my dense breasts, I would have sought additional screening,” she adds.
“I believe my tumours could have been found at a smaller and less advanced stage and I wouldn’t have had to endure such extensive treatment, including a double mastectomy.”
Lack of awareness is “deeply concerning”
Adrian Waller, CEO of Micrima, which has developed a specialised scanning technology to analyse breast tissue without the need for a hospital visit, described the lack of awareness in the UK as “deeply concerning”.
“Breast density is known within the medical community, but it is not part of the standard pathway for either breast cancer screening or symptomatic service,” Waller explains.
“Our medical services have not had the resources or capacity to provide the supplemental testing required to improve detection rates for women with dense breasts.
“This is compounded as currently the only way of measuring breast density is from a woman’s initial mammogram. Until the development of Micrima’s RF based device Mi~Scan®, there hasn’t been the technology available to measure breast density simply and effectively.”
Mi~Scan®, which has shown “strong initial results” in the clinical trial phase, is designed to analyse breast tissue quickly and painlessly— without ionising radiation— to help clinicians identify the right diagnostic test for cancer detection.
“We want women to be empowered with the knowledge of their breast density so they can be in greater control of their breast health,” continues Waller.
“We also want to support the medical and radiology communities to explore and build in density measurement within the breast screening pathway, enabling more efficient delivery of personalised diagnostic pathways.”
CEO of Micrima, Adrian Waller, is calling for government regulation.
Calls for government regulation
Awareness of breast density is thought to be higher in the US, where a new FDA ruling – introduced earlier this month – requires all mammography reports and results sent to patients to include an assessment of breast density.
Waller and others are also calling for similar regulation in the UK.
“We would like to see the Government regulate around women being told their breast density when they receive results from a mammogram – much like has happened in the States,” he adds.
“Ultimately, we would like women to have their breast density measured routinely at a community level, in order for GPs or Community Diagnostic Centres to create an individualised risk profile for each of their patients.”
“Lifting the lid” on breast density
Leslie Ferris Yerger, founder and CEO of the charity My Density Matters, was diagnosed with Stage IV breast cancer in 2017, just two months after a routine mammogram and ultrasound gave her the ‘ all clear’.
“Hidden by dense breast tissue, my cancer was left to grow and spread,” she says.
“Breast density is so important and Micrima’s research spotlights that we must do more to lift the lid on breast density and let women know why it matters. We need to empower women with knowledge so they can take ownership of their breast health. When we catch cancer sooner, the chances of survival are greater.”
An AI atlas has mapped how reproductive organs age through menopause, with the ovaries, vagina and uterus changing on different timelines.
To better understand how this process affects health, researchers at the Barcelona Supercomputing Center developed what they describe as the first large-scale atlas of female reproductive system ageing, using artificial intelligence.
The team combined 1,112 tissue images from 659 samples, covering 304 women aged 20 to 70, with gene expression data from thousands of genes.
This allowed them to reconstruct how seven key reproductive organs, including the uterus, ovary, vagina, cervix, breast and fallopian tubes, age over time.
The study used the supercomputing power of MareNostrum 5 together with advanced image-recognition methods to process the data.
Using deep learning techniques, the researchers detected visible tissue changes as well as the underlying molecular processes linked to ageing in each organ.
The result was a detailed, organ-by-organ map of the reproductive system’s ageing process.
The researchers found that not all organs age in the same way or at the same speed. The ovaries and vagina showed a more gradual ageing process that begins even before menopause officially starts.
By contrast, the uterus appeared to undergo more sudden changes around the time of menopause.
Even within a single organ, different tissues aged at different rates. In the uterus, for example, the mucosa, its inner lining, and the muscular layer did not change in sync. These tissues also appeared to be particularly sensitive to the hormonal and biological shifts associated with menopause.
Marta Melé, leader of the transcriptomics and functional genomics group at BSC and director of the study, said: “Our results show that it acts as a turning point that profoundly reorganises other organs and tissues of the reproductive system, and allows us to identify the genes and molecular processes that could be behind these changes.”
Building on the finding that organs age according to different patterns, co-first author Laura Ventura said the research “paves the way for personalised medicine where treatments are tailored to a woman’s specific molecular profile and the specific tissues showing the most age-related distress.”
The study also identified molecular signals linked to reproductive ageing that can be detected in blood samples from more than 21,441 women.
These biomarkers could allow doctors to monitor the condition of reproductive organs in a non-invasive way, potentially helping to anticipate risks such as pelvic floor complications without the need for biopsies.
According to the researchers, this could lead to simpler and more accessible clinical tools for tracking women’s health over time.
Ovarian cancer cases are rising among younger adults in England, with bowel cancer showing a similar pattern, a new study suggests.
Researchers said excess weight is a key contributor, but is unlikely on its own to explain the pattern.
The authors wrote: “These patterns suggest that while similar risk factors across ages are likely, some cancers may have age-specific exposures, susceptibilities, or differences in screening and detection practices.”
They added: “Although overweight and obesity are linked to 10 of the 11 cancers evaluated and account for a substantial proportion of cancer cases, both BMI-attributable and BMI-non-attributable incidence rates have increased, though the latter more slowly, suggesting other contributors.”
The study analysed cancer incidence, meaning new diagnoses, in England between 2001 and 2019 across more than 20 cancer types, comparing adults aged 20 to 49 with those aged 50 and over.
Among younger women, cases of 16 out of 22 cancers increased significantly over the period, while among younger men, 11 out of 21 cancers increased significantly.
In particular, there was a significant rise in 11 cancers with known behavioural risk factors among adults under 50. These were thyroid, multiple myeloma, liver, kidney, gallbladder, bowel, pancreatic, endometrial, mouth, breast and ovarian cancers.
Rates of all 11 also rose significantly among adults aged 50 and over, with the notable exceptions of bowel and ovarian cancer.
Five cancers, endometrial, kidney, pancreatic, multiple myeloma and thyroid cancer, increased significantly faster in younger than in older women, while multiple myeloma increased faster in younger than in older men.
The researchers looked at established risk factors including smoking, alcohol intake, diet, physical inactivity and body mass index, a measure used to assess whether someone is underweight, a healthy weight, overweight or obese.
With the exception of mouth cancer, all 11 cancers were associated with obesity. Six, liver, bowel, mouth, pancreatic, kidney and ovarian, were also linked to smoking.
Four, liver, bowel, mouth and breast, were associated with alcohol intake. Three, bowel, breast and endometrial, were linked to physical inactivity, and one, bowel, was associated with dietary factors.
But apart from excess weight, trends in those risk factors over the past one to two decades were stable or improving among younger adults.
That suggests other factors may also play a part, including reproductive history, early-life or prenatal exposures, and changes in diagnosis and detection.
The study noted that red meat consumption fell among younger adults, while fibre intake remained stable or slightly improved in both sexes between 2009 and 2019, although more than 90 per cent of younger adults were still not eating enough fibre in 2018.
Established behavioural risk factors accounted for a substantial share of cancer cases.
Excess weight was the risk factor associated with most cancers in 2019, ranging from 5 per cent for ovarian cancer to 37 per cent for endometrial cancer.
The researchers said the findings were based on observational data, meaning the study could identify patterns but could not prove cause and effect.
They also noted there were no consistent long-term national data for several risk factors, that the analysis was limited to England rather than the UK, and that cancer remains far more common overall in older adults despite the rise in cases among younger people.
Early miscarriage care after a first loss could prevent about 10,000 pregnancy losses a year in the UK, according to a new study.
The study by Tommy’s National Centre for Miscarriage Research and Birmingham women’s hospital involving 406 women found a 4 per cent reduction in the risk of future miscarriage for women on the graded model of care compared with usual care.
Women in England, Wales and Northern Ireland currently become eligible for specialised NHS care for early baby loss only after they have had at least three miscarriages.
Tommy’s has called for women to become eligible after one miscarriage, saying this could reduce the risk of future miscarriages and improve health outcomes for mothers.
Researchers said that would translate to 10,075 fewer miscarriages a year across the UK.
Kath Abrahams, chief executive of Tommy’s, said women were being “left without early access to services that could help prevent future losses and reduce the debilitating feelings of isolation and hopelessness that we know affect so many who experience pregnancy loss”.
She said: “Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care.
“Put simply, it is the right thing to do. We will do all we can to drive that change across the UK so that more women and families are supported after every miscarriage.”
The graded model of miscarriage care proposed by Tommy’s is already available in Scotland, and the charity is calling for it to be introduced across the whole of the UK.
The graded model includes nurse-led support after one miscarriage, with advice on reducing risk factors such as low vitamin D, folic acid intake, alcohol consumption and caffeine use.
Women who received the specialised care were 47 per cent more likely to have a risk factor identified and receive relevant advice to help prevent future miscarriages than women receiving usual care, the study found.
Among women who had experienced two miscarriages and received the specialised care, one in five were found to have thyroid dysfunction or anaemia, both conditions that can affect pregnancy outcomes.
About one in four pregnancies ends in miscarriage, most often within the first 12 weeks of pregnancy.
The report comes ahead of the long-awaited final findings of the government’s investigation into maternity care in England. Interim findings uncovered a range of failures, including claims that NHS hospitals that caused harm to women and babies during childbirth often resorted to a “cover-up” of their mistakes, falsified medical records and denied bereaved parents answers.
Women’s health minister Gillian Merron said: “Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need.
“I welcome the findings of this important report, and this will be carefully considered as part of our ongoing work to make sure women get the high-quality, compassionate NHS care they deserve.”
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