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Breast density— the cancer risk factor millions of women may not know about

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Clare Cowhig was diagnosed with breast cancer at the age of 50, nine months after her mammogram came back 'all clear'.

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.”  

 

Mental health

Cosmetic procedures may become addictive for some women, researchers say

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Cosmetic procedures may become addiction-like for some women, with low body esteem and problematic social media use linked to higher risk, new research suggests.

A study of 1,614 women aged 25 to 71 found that one in five who had undergone treatments met the threshold for moderate to severe risk of addictive cosmetic procedure use.

Low body esteem and problematic social media use emerged as the strongest risk factors.

Researchers from the Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health examined what they described as addictive cosmetic procedure use, or ACPU, among Jewish Israeli women.

ACPU refers to repeated cosmetic treatment behaviour that may resemble addiction, including feeling unable to stop, continuing despite negative effects or craving further procedures.

The study was led by Vera Skvirsky alongside Uri Lifshin, Dvora Shmulewitz and Mario Mikulincer, from the department of psychology at the Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health.

The researchers surveyed women from the general population rather than focusing only on patients at cosmetic clinics.

Among women who had undergone cosmetic procedures, 20 per cent met the threshold for moderate to severe lifetime risk, while more than 15 per cent reported symptoms within the previous year.

Across the full sample, nearly nine per cent of women showed moderate to severe signs of problematic cosmetic procedure use.

The researchers adapted questions based on mental health criteria used to assess substance-related disorders.

Participants were asked whether they had tried unsuccessfully to stop having cosmetic procedures, felt compelled to continue despite negative consequences or experienced cravings linked to treatment.

Previous research has linked cosmetic procedures with body-image concerns and body dysmorphic disorder.

Body dysmorphic disorder is a mental health condition in which a person becomes highly distressed by perceived flaws in their appearance, often flaws that others may not notice.

The new study examined whether repeated cosmetic procedures may, in some cases, resemble a behavioural addiction.

Women with lower body esteem were more likely to report addiction-like patterns, particularly when this was combined with high levels of problematic social media use.

Participants who reported problematic or excessive social media behaviour appeared especially vulnerable when they also felt dissatisfied with their appearance.

The researchers also found smaller links between addictive cosmetic procedure use and lower feminist attitudes, lower attachment security and more negative attitudes towards ageing.

However, those links were less consistent when several factors were analysed together.

The findings come amid a sharp global rise in cosmetic procedures, with international estimates cited by the researchers suggesting interventions increased by around 40 per cent between 2019 and 2023.

The researchers stressed that the study does not suggest cosmetic procedures are inherently harmful.

Instead, they said repeated engagement may, for some people, take on characteristics similar to behavioural addictions already recognised in mental health research.

The researchers said: “Cosmetic procedures have become deeply normalised in many societies, and for many people they may be a positive experience.

“But our findings suggest that for a meaningful minority, the behaviour may begin to resemble other compulsive patterns we see in addiction research, especially when low body esteem and problematic social media use are involved.”

The study was cross-sectional, meaning it captured a single point in time and cannot prove cause and effect.

Researchers said it remains unclear whether problematic social media use contributes to addiction-like cosmetic procedure behaviour, whether treatments influence body image and online engagement, or whether other psychological factors drive both.

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Pregnancy

New pregnancy treatment shows promise for at-risk twins

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A high-powered ultrasound treatment could help identical twins affected by a rare and serious condition during early pregnancy, an initial study suggests.

Twin-to-twin transfusion syndrome, or TTTS, causes uneven blood flow between identical twins who share a placenta.

The imbalance can leave one baby dangerously small and the other too large, putting both babies’ survival at risk.

 

Brioney Garrett’s daughters were in danger before doctors used the world-first treatment to seal the blood vessels causing the problem without an operation.

Nancy and Margo were born healthy and, now aged four, are due to start school.

Researchers from Queen Charlotte’s and Chelsea Hospital tested the non-invasive procedure in 10 women from the UK and elsewhere in Europe after scans detected TTTS during early pregnancy.

Five women needed further treatment, while 12 of the 20 babies survived following the procedure.

The researchers described having a treatment that did not require a needle or telescope to be inserted into the mother’s abdomen as “extremely exciting”.

However, they said larger studies involving more pregnant women were needed before the procedure could be offered more widely.

Garrett described her daughters as “my miracle twins”.

She said: “We were in a very dire situation and I don’t forget that.

“It stays with me always how things could have been. Every day I still count my blessings.”

TTTS affects between 10 and 15 per cent of identical twins who share a placenta, representing around 300 to 400 pregnancies in the UK each year.

The uneven blood flow causes excess fluid to build up around the larger recipient baby, while leaving dangerously little fluid around the smaller donor baby.

Treatment usually involves inserting a needle into the womb to drain some of the fluid or using a laser to seal the connecting blood vessels.

Garrett’s procedure took about 20 minutes. She lay flat while a specially designed machine directed high-powered ultrasound waves at small blood vessels in her placenta.

She said: “It was very quick and pretty painless.”

Christoph Lees, head of fetal medicine at Imperial College Healthcare NHS Trust and professor of obstetrics at Imperial College London, described the research as “very promising”.

He said: “If this could work in a fully-fledged study, it could give hope to a lot of women who otherwise might have to have quite invasive treatment.”

Ultrasound is commonly used during medical scans to produce images of the body, but this procedure uses much more focused waves.

Heat generated by the waves can seal blood vessels about 2mm in diameter and located around 5cm to 6cm beneath the skin.

The procedure blocked blood flow in 90 per cent of the vessels treated during the study, with no unwanted side-effects reported.

Twins Trust, which supported the study, said the approach could make a significant difference for families affected by TTTS.

Helen Peck, head of healthcare engagement and research, said: “Any procedure that is non-invasive and can potentially identify TTTS earlier and improve outcomes for our families with this life-threatening condition could be a turning point.”

Scans carried out weeks after Garrett’s procedure showed that blood flow between the babies had been rebalanced, although other problems developed during the pregnancy.

Garrett said Margo, who had too little fluid around her, “was in a much better position” and that “the strain on Nancy’s heart had eased”.

Nancy and Margo were born at nearly 34 weeks, weighing 3lb 7oz and 3lb 3oz respectively.

Garrett said: “They were both healthy, and Margo wasn’t as small as we worried she was going to be.”

The twins are due to start primary school in September.

Garrett said: “They’re funny, smart, energetic little girls that just fit right in with their age group.”

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Insight

Breast cancer rising rapidly in Asian American women, study finds

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Breast cancer rates have risen rapidly among Asian American women over the past two decades, with some of the steepest increases among women under 50, new research has revealed.

Rates rose by more than three per cent a year in nearly every Asian American ethnic group studied, much faster than in any other US ethnic group.

The increase was particularly marked among women under 50 and in cases involving advanced-stage disease or certain aggressive subtypes of the cancer.

The study found even larger increases among Chinese and Vietnamese women.

Breast cancer rates among Native Hawaiian women were already among the highest recorded among US women, but rose by about one per cent a year, less than the increases seen in Asian American groups.

The researchers said increased screening was unlikely to explain the trend because screening would be expected to identify more cancers at an earlier stage.

Instead, cancers that had already spread increased at the fastest rate.

Triple-negative breast cancer, considered the most aggressive subtype, rose by more than six per cent a year among Chinese American women between 2017 and 2022.

Scarlett Lin Gomez, senior author and professor of epidemiology and biostatistics at the University of California, San Francisco, said: “These patterns are highly concerning from a disparities standpoint.

“They underscore why it is so important to move beyond treating Asian Americans, Native Hawaiians, and Pacific Islanders as a single population.”

Researchers analysed about 150,000 cases of invasive breast cancer diagnosed between 2000 and 2022 using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Programme.

The analysis covered nine Asian American, Native Hawaiian and Pacific Islander populations across 14 states. Together, these states account for about two-thirds of the US population within these groups.

Except for Native Hawaiian women, Asian American women have historically had lower breast cancer rates than non-Hispanic white women.

However, the gap has narrowed rapidly. By 2022, incidence among Asian American women under 50 was comparable with that recorded among white women.

The reasons for the increase among women under 50 remain unclear.

Changes in reproductive patterns, diet and other lifestyle factors may play a part, but researchers said they did not fully explain the findings.

They said previously unidentified risk factors may also be contributing to the rises in some Asian American communities.

Researchers hope two UCSF-based studies, the CRANE breast cancer study and the ASPIRE cohort study, will provide insights into these factors.

Gomez said: “Understanding why breast cancer is increasing so rapidly in these communities is critical.

“At the same time, we need to ensure that women across all Asian American, Native Hawaiian, and Pacific Islander communities have access to culturally appropriate education, screening, and timely follow-up care.”

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