Why I care about women’s health

I am part of an all-women team at Phenogen Sciences, Inc, a US subsidiary of Genetic Technologies. We are scientists, business women and mothers. We are passionate about preventative healthcare and making sure that women have the tools and resources available to them to make the best decisions for their health. Every women’s healthcare choices reflect her individual options and circumstances.

In our fields, we learn something new everyday, whether it’s from a physician, researcher, or patient, and this blog is our opportunity to share what we learn with all the women. Being well-informed empowers us to make the best decisions for ourselves and our families. Our blog posts do not necessarily reflect the opinions/views of the company’s. 

I grew up playing boys hockey. I always hated being considered “different” as a girl. I wanted to just blend in as one of the guys. In some circumstances, it’s perfectly fine wanting, demanding and receiving equal treatment to the guys (that’s a topic for a different blog). But when it comes to healthcare, I do want to be recognized as a female. And I do want to be treated differently.

There is a long history of women’s healthcare taking a backseat to men’s. Most of today’s medicine is based on safety, efficacy and tolerance studies on men, not women–even things as simple as low-dose aspirin! We, as women, have different body compositions and hormone levels compared to men; just these things alone are going to change how a drug works in our bodies compared to a man’s. And, let’s face it, we can grow a tiny human in our bodies, there are obviously a lot of other small differences. So, women’s health is important to me–hey I’m a woman. Heart disease and cancer are the top two causes of death in women. My background is in cancer biology, and breast cancer is of special interest to me. 1 in 8 of us get it. My mission is to introduce breast cancer awareness topics so that women are aware of their breast cancer risks and empowered to have the right conversations with their healthcare providers. But this same concept can be applied to focus on prevention for many different diseases. As our company brings several new products to the market, I will continue to add content across broader disease areas.

I played NCAA women’s ice hockey at (and got my BS in molecular biology from) UCONN before getting my doctorate from University of Texas Graduate School of Biomedical Sciences. After doing my post-doctoral studies at MD Anderson Cancer Center, I moved into the field of translational genomics. In my current position with Phenogen Science, I work in clinical affairs and medical education to help commercialize our clinical risk assessment tests for breast cancer. The lack of comprehensive access to breast health awareness across the US surprised me–this is a space for me to provide basic resources from the perspective of a science-loving, boy-mom, phD who is honored to get to interact with, speak-to and learn-from some of the brightest clinicians and scientists in women’s health. 

Breast Lobules Come and Go

Lobules are the part of your breast that make milk (they’re actually glands). If you’ve given birth, you are sure to remember how your breasts changed over the course of your pregnancy…and then voila, like magic you are suddenly able to feed a tiny human.

OK. It’s not magic. We know why the breast change post-pregnancy–your lobules are now capable of making milk. There is a lot of change that your breasts undergo to be ready to produce milk (we can talk about that another time). But, when you are done breastfeeding, whether it’s on day one, or day 500, your breasts change again! This change is called postlactational involution.

You’re body gets the signal that it no longer needs to make milk, and all the cells that were supporting the process of milk-making, now turn on the self-destruct signal. That’s right, it sounds a bit harsh, but they know they are no longer need–and poof, they begin the process of clearing out so your breast goes back to a pre-pregnancy state (although most of us don’t seem to go back to that pre-pregnancy perkiness).

Sometimes, the cells in your breasts may get confused. This postlactational involution process is actually quite complicated and sometimes your cells make a mistake and can’t actually figure out how to complete the involution process. Women with incomplete involution are known to have an increased risk of developing breast cancer. Without a breast biopsy, your doctor can’t tell if you have undergone complete involution–so it’s a difficult risk factor to account for.

Although we don’t know all the reasons why, there is a 10-year window after giving birth, where your risk of breast cancer is increased. Development of breast cancer within this 10-year window is called, postpartum breast cancer.

During the involution process, there is a lot of inflammation due to all the “rearrangement” going on in the breast tissue. This inflammation may promote tumor growth in some circumstances. There is some evidence that breastfeeding longer than 6 months can be protective against some of these pro-inflammatory cellular changes. And we know every 12 months of breastfeeding reduces your risk of developing breast cancer. Just keep in mind, breast feeding is just one of many factors; just because you breastfed doesn’t mean you’re completely “protected.”

Finally, there is another type of involution that every woman goes through, regardless of whether she gave birth, or not. This is age-related lobular involution and typically starts around 40. The first type of involution we talked about involved the milk-producing-breasts shrinking back to normal. But, the age-related involution actually permanently replaces 75% or more of your lobules with collagen and fat. Studies have shown that women with complete involution are at lower risk of developing breast cancer.

During these lobular involution processes, your body is hard at work “remodeling” your breast tissue…and you’d never know it! Your body is pretty amazing, but occasionally “routine maintenance” can go off-course. You know your body best, trust your instincts and as always, stay up-to-date on your breast cancer screening.

  1. Basree, M.M., Shinde, N., Koivisto, C. et al. Abrupt involution induces inflammation, estrogenic signaling, and hyperplasia linking lack of breastfeeding with increased risk of breast cancer. Breast Cancer Res 21, 80 (2019). 
  2. Tia R. Milanese, Lynn C. Hartmann, Thomas A. Sellers, Marlene H. Frost, Robert A. Vierkant, Shaun D. Maloney, V. Shane Pankratz, Amy C. Degnim, Celine M. Vachon, Carol A. Reynolds, Romayne A. Thompson, L. Joseph Melton, III, Ellen L. Goode, Daniel W. Visscher, Age-Related Lobular Involution and Risk of Breast Cancer, JNCI: Journal of the National Cancer Institute, 98, 22, 15 (2006)
  3. Maskarinec, G., Ju, D., Horio, D. et al. Involution of breast tissue and mammographic density. Breast Cancer Res 18, 128 (2016).

Breast Density, Say What?

You received a letter that says something about dense breast tissue. OK. Now what? What does the language really mean. And what should you be doing about it?

Nearly half of all women have dense breast tissue, so it’s common. Breast density officially refers to the amount of fibroglandular tissue in your breast, relative to the amount of fat. I know it’s tempting to look down and maybe give your boobs a little squeeze at this point. But, it’s not like squeezing the fat on your love handles! You cannot “feel” the difference between the fatty and the dense tissue with your hands. Yep, droopy-post-pregnancy-boobs can still be dense! But let’s talk about what density means, and why it’s important to know your breast density.

Bottom line, having dense breast tissue can increase your risk of developing breast cancer. But, don’t panic. If you have dense breast tissue, your doctor may do an additional screening with another method, like ultrasound. Your doctor also may ask you about your other risk factors to get a bigger picture of your risk. There are no specific recommendations for doctors to follow based on breast density, so the best thing that you can do is know what your breast density is, and then ask your doctor what the plan is to make sure that you are receiving the best screening possible for your breast tissue type and your breast cancer risk.

There are two mains ways to report breast density. Most commonly, your letter/report will have BI-RADS categories on it. The BI-RADS categories are more qualitative than quantitative. When you are reading your mammogram summary or breast density notification letter, look for some of the keywords in the bullet list below. You should be able to figure out what BI-RADS category you fall into!

Percent volumetric breast density =  the calculation of the volume of fibroglandular (aka dense) tissue divided by the total volume of tissue within the breast.

BI-RADS = the description of the amount of fibroglandular (aka dense) tissue seen on a mammogram

  • BI-RADS A: the breasts are almost entirely fatty. about 1 in 10 women are in this group.
  • BI-RADS B: there are scattered areas of fibroglandular density, but most of the breast is fat tissue. About 4 in 10 women are in this group.
  • BI-RADS C: the breasts are heterogeneously dense, there are small areas of fat, by most of the tissue is dense. About 4 in 10 women are in this group.
  • BI-RADS D: the breasts are extremely dense, which lowers the sensitivity of mammography. About 1 in 10 women are in this group.
These four images represent different levels of breast density based on BI-RADS A, B, C and D (from left to right). You can see the fibroglandular (aka dense) tissue in white and the fatty tissue in gray.

Women with BI-RADS C and D are at higher risk of developing breast cancer in part because it can be harder to “see” a potential tumor because it blends in with the dense tissue. As you can see in the picture, the dense tissue is white. A breast tumor will also show up as white within the image, so it can be more difficult for a radiologist to distinguish between the tumor and the fibroglandular tissue in a woman with dense breasts.

Density can actually change as you age, and as the hormone levels change in your body. It can even change based on medication you may be on. So, your breast density last year may not be the same next year. Stay current with your mammograms. Make sure you ask your clinician about your breast density status. It shouldn’t be a secret!

What is a false-positive mammogram?

You get your mammogram. You go home. You get a call asking you to schedule a follow up mammogram. What?! You are a bit worried, race to Dr. Google for some advice. Dr. Google does a great job of providing you with every worst-case scenario. Your anxiety is up. And then it turns out it was dense breast tissue, a small calcification, or a benign biopsy–not breast cancer.

Most of the time, when the radiologist sees “something” on your mammogram and they call you back in to have a closer look, or take a biopsy, it will turn out to be a “false positive.” In fact, about 80% of breast biopsies conducted are benign. And if you and your best friend got mammogram together every year for 10 years in a row, the chances are one of you will have a false positive mammogram at least one time!1 So, it’s fairly common to have a false positive mammogram.

What does this actually mean to your breast cancer risk? Well, having a false positive mammogram does slightly increase your risk of developing your risk of breast cancer.2 At least for ten years following that false-positive event.

The image from your false-positive mammogram showed something that made your doctor think twice–this happens a lot in women who have dense breast tissue because the dense tissue often looks mistakingly similar to the way a small tumor might appear in the image. A tumor can more easily hide in dense breast tissue. This is one of the reasons that having dense breast tissue can increase your risk of breast cancer.3

After a false positive event, we don’t want you to be anxious bout your risk of developing breast cancer. We want you to be aware of your risks, and feel confident that you are taking the steps you need in order to reduce your risk. Talk to your healthcare provider about your risk–there are loads of other risk factors that influence your risk of developing breast cancer. And there is no magic combination. Don’t be shy about asking your healthcare provider a question–there aren’t any stupid questions when it comes to your health. And finally, remember to listen to your body–you are your own best advocate.

  1. Hubbard RA, Kerlikowske K, Flowers CI, Yankaskas BC, Zhu W, Miglioretti DL. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med. 2011;155(8):481-92.
  2. Henderson LM, Hubbard, RA Sprague BL, Zhu W, Kerlikowske K. Increased Risk of Developing Breast Cancer after a False-Positive Screening Mammogram. Cancer Epidemiol Biomarkers Prev. 2015;24(12) 1882-1889,.
  3. Holland K, van Gils CH, Mann RM, Karssemeijer N. Quantification of masking risk in screening mammography with volumetric breast density maps. Breast Cancer Res Treat. 2017;162(3):541-548.
This cartoon was published in “The Record of Hackensack”, in New Jersey, on 11/20/2009. In mammogram screening guidelines put forth by the US Preventative Services Task Force, one “harm” of screening includes the anxiety of false positive results, and for this reason, they do not recommend screening between 40-49. However, the benefit is actually saving a woman’s life through early detection. When asked, most women feel that saving one women’s life is worth a few thousand false positives.

Should I get a BRCA test?

It’s breast cancer awareness month. There are bound to be stories about women who tested positive for a BRCA1 or BRCA2 mutation. Now after a double-mastectomy, they are breast-cancer worry free… Is this an option for you?

Probably not.

In reality, most women tested for a BRCA1/2 variant will come back negative as carriers. This means the woman will not “carry” (aka have) the “variant” (aka mutation) in one of these genes (BRCA1 or BRCA2) associated with high risk of developing breast cancer.

1 in 400 women will be positive for a BRCA1 variant. *these aren’t men, they are pant-wearing women*

In fact, most women won’t even qualify for BRCA-testing, based on their family history of breast cancer (so much more on this topic at a later date). So if you are still interested in your chances of being a one in 400, you will likely be paying out-of-pocket.

“But if I come back negative for a BRCA mutation, I don’t have to worry about my risk of developing breast cancer.” said by the falsely-secure woman who just paid for an unnamed genetics test .

Wrong!

While having a BRCA1 or BRCA2 mutation can really increase your risk of developing breast cancer. Not having a mutation doesn’t make you safe. That was a double negative. Let me try again. You are still at risk of breast cancer, even if you are mutation-free. In fact, fewer than 10% of women who have breast cancer actually have a BRCA1/2 mutation.

Looking at women with breast cancer, less than 10% will be BRCA1/2 positive.

Then, why all the hype about BRCA mutations if so few women with breast cancer actually have one?

The BRCA1/2 genes play a really important role in breast cancer development–the hype is necessary. It is extremely important to identify those women that do have this mutation. These women are at significant risk of developing breast cancer–up to 80% chance. By identifying these women at a young age, they can have extra screening and in some circumstances risk-reducing medication and/or surgery to help prevent breast cancer.

The problem is the lack of hype for all the rest of the breast cancer risk factors. Because, most of us (399 out of 400) do not carry a BRCA mutation; and yet 1 in 8 of us will still develop breast cancer.

1 in 8 women (or 50 in 400 women) will develop breast cancer in her lifetime. Most of these women won’t have a BRCA mutation.

The bottom line:

  • BRCA-testing is important for many women. Knowing if you are a BRCA-mutation carrier can enable you access to life-saving screening and prevention options.
  • Just because you come back negative does not mean you’re “safe.” Talk to your healthcare provider about your risks of developing breast cancer.

Intro to Breast Cancer Risk Factors

There are a lot of different risk factors associated with breast cancer development. This article will take a really broad look at some of the general risk factors–but we will dig deeper into each risk factor in subsequent posts! Stay-tuned, or join our email list to stay informed!

Where to begin?! There are so many little risk factors! When I say little, it means that the risk factor all by itself amounts to a little bit of risk. Alone, the risk factor does not really seem too important. But, when you start looking at all of these little risk factors together…they start to pile up. Think of a children’s block tower.

We’ve put together a list of risk factors. We will dedicate other pages to go into the details of each risk factor individually.

The bigger risk factors:

  • age
  • genetics
  • family history of breast cancer
  • biopsy status including atypical hyperplasia or LCIS
  • radiation treatment as a child

The smaller risk factors (that can still add up):

  • breast density
  • height
  • BMI after menopause
  • age at your 1st period
  • given birth before
  • birthweight
  • your age at the birth of your 1st child
  • how long ago you last gave birth
  • oral contraception use
  • age at menopause
  • hormone replacement therapy use
  • previous negative biopsy findings
  • alcohol intake
  • sedentary behavior
  • night shift work
  • race and ethnicity

These are just some of the risk factors that can influence your risk of developing breast cancer. We define some as “bigger” risk factors–think of this as the risk being a bit more “important” than another risk factor–if we had to compare them.

Risk assessment models take some of these risk factors into account. No risk assessment looks at the exact same combination of factors. In some circumstances, your clinician may use a combination of risk models to get the best picture of your risk. Ultimately the goal of looking at and understanding your risk factors is to be able to address small changes you might be able to make. Small changes might be lifestyle habits, but it might also be just an increased awareness on your part. Knowing your personal risk factors may also help you stay vigilant with your screening schedule.