Tailor Hofman, originally from St. Peter, Minnesota, was in middle school when her great-grandmother was diagnosed with breast cancer and underwent a mastectomy.

"My great-grandma and I shared a close bond," Hofman says. "Her experience had a significant emotional impact on our family, particularly because we're a family of many women." 

Years later, Hofman was inspired to train for a career where she could help other women through breast cancer screening. She applied to the radiography program at Mayo Clinic School of Health Sciences to become a radiologic technologist — also known as a radiographer — working with doctors in assessing and evaluating patients, often using breast imaging. 

Across the schools of Mayo Clinic College of Medicine and Science, programs are training future leaders in approaches that address the breast cancer journey, from the first moment of screening to the years after a diagnosis. Often inspired by the cancer diagnoses of family and friends, students are learning cutting-edge approaches and bringing Mayo Clinic's primary value — the needs of the patient come first — to breast cancer care.  

Making a difference in testing and treatment 

Today, Hofman's work as a Mayo Clinic radiographer allows her to build relationships with patients starting from their first screenings. 

"The team in breast imaging has unique insight into the care they provide," says Jessica Lodermeier, director of the radiography program in Rochester, Minnesota, which graduates up to 34 students a year. "They understand the emotional stress and anxiety that can accompany this very important yearly exam for women." 

Radiographers perform medical exams using X-rays and other technology to create images that are interpreted by doctors for diagnosis and treatment of disease. Mayo's program allows them to add specialized training in magnetic resonance imaging (MRI), computerized tomography (CT), mammography and other areas. 

The School of Health Sciences has radiography programs on Mayo campuses in Rochester and Florida and offers a radiography internship program in Arizona. Instructors are experienced radiologic technologists, working side by side with students to share their expertise. 

"Our faculty is devoted to each student learner, and building on their interests in specific areas, such as various breast imaging technologies," says Lodermeier, who is also an alumna of the program. "For many students who choose radiography, it's to make a difference — caring for patients by assisting in testing and treatment of breast cancer and other serious diseases." 

Combining advanced techniques and compassionate care

Programs at Mayo Clinic also are training clinicians in specialized care for patients with breast cancer. One such program is a fellowship that focuses on breast imaging, offered through Mayo Clinic School of Graduate Medical Education. A fellowship program exists on each of Mayo's campuses, admitting a total of about six trainees a year. 

Fellows learn numerous advanced imaging technologies, including modalities not offered at many institutions, such as contrast-enhanced digital mammography (CEDM) and molecular breast imaging (MBI). These approaches can improve cancer detection.

In Florida, the Breast Imaging Fellowship program — which accepts one fellow a year — involves rigorous training rotations that take place in the state-of-the-art facilities of the Duan Family Building. The training  emphasizes compassion, says program director Kristin Robinson, M.D. Among recent trainees in Florida was Michael Villalba, D.O., who completed the program and was hired to join Mayo staff as a physician in diagnostic radiology specializing in breast imaging. 

The compassionate care Dr. Villalba provided during a biopsy made an impression on patient Shelley Norwood. "His passion shines through in how he engages with patients," Norwood says. "You can see it in his face and hear it in his voice. He exemplifies the Mayo mission and values." 

This approach is embedded in the fellowship training, says Dr. Robinson. "We're not just reading images,” she says. "We're caring for people." 

Improving outcomes for patients

Mayo is also training students who have an eye on patients' futures. Anna Detry is a fourth year Ph.D. student at Mayo Clinic Graduate School of Biomedical Sciences. Training under the mentorship of cancer researcher John Hawse IV, Ph.D., she aims to improve outcomes for patients who have recurrent breast tumors that have become resistant to treatment.

Detry took interest in studying breast cancer after family friends faced cancer diagnoses. Her studies focus on a form of breast cancer classified as estrogen receptor positive (ER+), which is usually treated effectively by drugs that block estrogen pathways. However, when tumors do recur, they may no longer respond to the same treatments. 

So far, her research has identified a previously unstudied protein, highly prevalent in metastatic ER+ tumors, that appears to help recurrent tumors thrive. "We're looking specifically at that protein to figure out how it's driving drug resistance and how we can target it," says Detry. The research team is now testing approaches to disable or eliminate the protein and restore the tumor's sensitivity to treatment.

Interacting with clinician collaborators at Mayo Clinic has helped shape Detry's thinking as a researcher-in-training who's zeroed in on what's next for patients. "When I was applying to graduate school, what drew me to Mayo was the patient-centric focus of everything, even very basic science studies," she says. "Being in a hospital setting and working with clinicians here constantly keeps the patient centered in all our work and in the forefront of our minds."

The post Shaping the future of breast cancer care–one trainee at a time appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have identified a specific immune cell that can be targeted to give a boost to standard immunotherapies for cancer. Two research teams, working collaboratively but using distinct approaches, found that "first-responder" immune cells known as myeloid cells can be manipulated to enhance the activity of tumor-killing T cells.

The finding suggests that enhanced myeloid cells may boost certain immune checkpoint therapies, which are the standard of care for some cancers but may not have lasting effects. A clinical trial is now being developed at Mayo Clinic to test the enhanced cells in patients.

In a study in Journal for ImmunoTherapy of Cancer, Mayo Clinic researchers detailed how they found a way to boost cancer-killing T cells. The goal was to improve treatments that interfere with immunosuppressive proteins, PD-1 and PD-L1, which together suppress T cells' ability to fight cancer. Even though PD-L1 immunotherapies aim to block PD-L1, the researchers found that the molecule can persist through a natural recycling process that puts it back in play.

"Our study found the importance of the recycling process, and we present a way to address it," says Haidong Dong, M.D., Ph.D., a cancer immunology researcher at Mayo Clinic Comprehensive Cancer Center and principal investigator of the study.

The research team developed an antibody, H1A, which they found can reduce PD-L1 in human myeloid cells and keep it from recycling. The protein PD-L1 is present in abundance on the surface of myeloid cells. When the protein was prevented from recycling on myeloid cells, the cells then boosted the action of cancer-killing T cells.

"We now have a tool that can completely remove PD-L1 and in doing so we have more myeloid cell activation," says lead author of the study, Michelle Hsu, who conducted the research as her graduate thesis at Mayo Clinic Graduate School of Biomedical Sciences. "Identifying the myeloid cell was an unexpected discovery," she says.

Another Mayo Clinic team took a different approach and arrived at a similar conclusion about the importance of myeloid cells. A research team led by immunology researcher Jessica Lancaster, Ph.D., at Mayo Clinic in Arizona, reported in iScience that macrophages, a type of myeloid cell, play a role in activating the cancer-killing T cells.

Watch animation

Animation available in the downloads: Live cell microscopy shows a cancer-killing T cell (magenta) as it migrates and interacts with macrophages (blue) in the tumor microenvironment. Black spaces are packed with non-fluorescent tumor cells. Image captured by Tina Kwok, Mayo Clinic.

Using the complex approach of live-cell microscopy, the team found that in mice, T cells interact closely with the macrophages and create a molecular environment that has greater capacity to kill a tumor.

"This is a paradigm shift for PD-L1 immunotherapy, which has traditionally focused on the interaction of the tumor and the T cells," says Dr. Lancaster. "We found that it’s important to co-opt the macrophage, which acts as another immune cell partner."

Further, says lead author Tina Kwok, who completed the studies during her Ph.D. research at Mayo Clinic, "We can directly reprogram tumor macrophages to be more pro-inflammatory. They can become better T-cell activators and drive better tumor control. Reprogramming of the macrophage may be key to being able to prevent therapy resistance and change outcomes for patients."

Based on the findings from both labs, a phase 1 clinical trial of H1A is being planned. The research could ultimately better address resistance to immunotherapy and expand treatment options for people with cancer.

Review the studies in Journal for ImmunoTherapy of Cancer and iScience for a complete list of authors, disclosures and funding.

###

About Mayo Clinic Comprehensive Cancer Center 
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic researchers find enhancing the body’s ‘first responder’ cells may boost immune therapy for cancer appeared first on Mayo Clinic News Network.

Primary sclerosing cholangitis (PSC) causes inflammation and scarring of the bile ducts. This rare liver disease is often accompanied by inflammatory bowel disease (IBD). Together, these diseases increase the risk of colorectal cancer by more than sixfold compared to the general population.

Until recently, it wasn't clear whether that increased colorectal cancer risk extended to people with PSC alone, but Mayo Clinic researchers have helped answer this question. Their findings could help open the door to earlier colorectal cancer screening and better prevention for people with PSC.

"We wanted to answer something that was overlooked in the guidelines because these patients are a smaller group and have been understudied in research," says Dr. Saqr Alsakarneh, a fellow in the Department of Gastroenterology at Mayo Clinic and lead author of the study, published in Alimentary Pharmacology and Therapeutics.

Searching data for cancer prevention blind spots

In the largest population-based analysis of its kind, Dr. Alsakarneh and his co-authors analyzed data from 115 million de-identified health records from 65 healthcare organizations across the U.S. Their goal was to understand long-term risk of colorectal and other gastrointestinal cancers in people with PSC.

The researchers found that people with PSC without IBD have nearly three times the risk of developing colorectal cancer compared to the general population. 

"This is important because it challenges the current assumption that only primary sclerosing cholangitis with IBD causes colorectal cancer," says Dr. Alsakarneh.

While colorectal cancer prevention guidelines recommend annual screening and increased surveillance for people who have PSC and IBD, no specific guidelines exist for people with only PSC. Dr. Alsakarneh says this is a missed opportunity for early detection of colorectal cancer, which is highly preventable with proper screening.

In addition to discovering an increased risk for colorectal cancer, the study confirmed an association between PSC alone and higher rates of bile duct, liver and pancreatic cancers. While previous research has suggested this connection, the study provides large-scale data to support the need for continued vigilance and screening strategies tailored to people with PSC.

Translating discovery to better care

Dr. Alsakarneh says these findings are an important first step toward a better understanding of PSC and cancer risk, although more studies are needed to confirm how this information should be incorporated into healthcare guidelines.

"Before anything is put into guidelines, the first step is always to validate the findings," says Dr. Alsakarneh. "Colleagues from the gastrointestinal community have reached out and are interested, so this is something we are working on."

As researchers investigate further, Dr. Alsakarneh says it's important that clinicians with PSC patients be aware of this association, tune into emerging evidence and keep their patients informed as findings develop.

Continuing a legacy of PSC discovery at Mayo Clinic

Dr. Alsakarneh's research continues a legacy of PSC discovery at Mayo Clinic that dates back to the '70s. That was when Dr. Nicholas LaRusso, a gastroenterologist at Mayo Clinic, first began studying the cluster of symptoms that he eventually helped describe and define as PSC in a 1980 study.

"It's important to me that this study comes from Mayo Clinic because Dr. LaRusso, who still has a lab here, made so much progress in this disease. He is the reason I came to Mayo Clinic to do my training," says Dr. Alsakarneh.

Alongside Dr. LaRusso, Dr. Alsakarneh next plans to lead Mayo Clinic research investigating why and how PSC increases cancer risk.

Review the study for a complete list of authors, disclosures and funding. 

The post Mayo Clinic study sheds light on colorectal cancer risk in overlooked group appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers collaborated on a new study showing that the drug abemaciclib improves survival for people with high-risk, early-stage breast cancer.

In the phase 3 monarchE trial, two years of abemaciclib (Verzenio) plus endocrine therapy reduced the risk of death by 15.8% compared with endocrine therapy alone among patients with a common type of early-stage breast cancer.

The clinical trial enrolled more than 5,600 patients at over 600 sites across 38 countries. All participants had breast cancer that was hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-), a subtype that includes 70% of all breast cancers, and also had cancer in at least one underarm lymph node, a factor linked to higher risk of recurrence.

"This is the first therapy to significantly prolong survival for this patient population in over two decades," says study co-author Matthew Goetz, M.D., a breast medical oncologist at Mayo Clinic Comprehensive Cancer Center. "With the addition of just one drug to standard endocrine therapy, we are not only seeing fewer recurrences but are also reducing the chance for breast cancer death."

These findings, published in the Annals of Oncology, establish abemaciclib plus endocrine therapy as the new standard of care for this high-risk group.

Abemaciclib is a CDK4/6 inhibitor, a type of drug that blocks proteins involved in cancer cell division. It is the first drug in its class approved by the Food and Drug Administration to treat node-positive, high-risk early breast cancer. Dr. Goetz previously led the MONARCH 3 clinical trial, which led to the FDA approval of abemaciclib in combination with hormone therapy for advanced HR+/HER2- breast cancer.

"Abemaciclib was developed to target estrogen receptor-positive breast cancer in a way that's different than chemotherapy by slowing the proliferation of cancer cells," Dr. Goetz says. "We now can confidently state that the benefits seen early on, in terms of reducing recurrence, result in improved survival, which is what matters most to patients."  

While most patients with HR+/HER2- breast cancer have good long-term outcomes, those with lymph-node involvement or large or high-grade tumors are more likely to experience recurrence.

Among patients who took abemaciclib with endocrine therapy, 32% fewer experienced disease spread after seven years compared with those who only received endocrine therapy. This confirms that abemaciclib helps lower the risk of recurrence even after treatment with the drug has ended.  

Continued follow-up will determine whether the survival benefit deepens over time.   

Review the study for a complete list of authors, disclosures and funding. The study was led by Eli Lilly. 

###

About Mayo Clinic Comprehensive Cancer Center 
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic collaborates on new drug study showing improved survival for early breast cancer appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A genomic test co-developed by Mayo Clinic and SkylineDx can identify whether people with melanoma are at low or high risk for cancer in their lymph nodes — a finding that could guide treatment decisions and help some people avoid lymph node biopsy surgery. The study results are published in JAMA Surgery.

In the largest prospective study of its kind, about 93% of people classified as low risk had no cancer in their lymph nodes, while about 25% in the high-risk group did. The multicenter clinical trial enrolled 1,761 people with early- or intermediate-stage melanoma at nine U.S. cancer centers between 2021 and 2024. 

Decoding the tumor’s genomic blueprint

The test measures the activity of eight genes in a melanoma tumor and combines that data with a person's age and tumor thickness to estimate the chance that cancer has reached the lymph nodes. The Merlin CP-GEP Test analyzes tissue from the tumor already collected during an initial biopsy, so no additional procedure or visit is required for the test.

Sentinel lymph node biopsy is performed under anesthesia to remove one or a few lymph nodes and check for microscopic cancer. The procedure usually requires a second incision and can have side effects, yet nearly 80% of people who undergo the surgery have no cancer in their lymph nodes.

"Surgery will always be central to cancer care, but this study shows that sentinel lymph node surgery might be avoided for selected patients with melanoma," says first author Tina Hieken, M.D., a surgical oncologist at the Mayo Clinic Comprehensive Cancer Center and co-principal investigator of the study. "This test lets us use a patient's own tumor biology to guide care with true precision."

Turning molecular insight into clinical impact

Melanoma is the deadliest form of skin cancer. While early-stage disease can often be treated successfully, once melanoma spreads to the lymph nodes, the risk of recurrence increases. Determining whether the cancer has reached the lymph nodes is a key step in guiding treatment.

"Melanoma progression is driven by subtle molecular processes that we're only beginning to understand," says Alexander Meves, M.D., a dermatologist at the Mayo Clinic Comprehensive Cancer Center who led earlier validation studies of the test. "This work translates that biology into tools that can improve care."

Researchers are now studying how incorporating the test into melanoma care might help healthcare professionals understand the risk of recurrence and guide follow-up care.

For a complete list of authors, disclosures and funding information, review the study.

###

About Mayo Clinic Comprehensive Cancer Center 
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post New genomic test could spare some people with melanoma from lymph node biopsy surgery  appeared first on Mayo Clinic News Network.

Radiation therapy is a common component of breast cancer treatment for patients. The high-powered beams of intense energy kill cancer cells and reduce the risk of the cancer recurring.

Dr. Laura Vallow, chair of the Radiation Oncology Department at Mayo Clinic in Florida, explains how innovation is transforming radiation treatments.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:05) is in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Read the script.

Patients with breast cancer now have more options when it comes to radiation treatments. The goal is to remove any remaining cancer cells following chemotherapy or surgery. 

"In other situations, we use radiation if the cancer is more advanced, or spread to the lymph nodes," says Dr. Vallow.

Advancements in technology allow healthcare professionals to treat patients more safely. One technique called "prone positioning" reduces the chance of beams targeting other organs. For this procedure, patients lie on their stomachs.

"We take advantage of gravity, the breast pulls away from the body, and we can treat the breast without exposing the underlying lung and heart to unnecessary radiation," explains Dr. Vallow.

Intensity-modulated radiation therapy is cutting-edge. Unlike traditional radiation, this procedure delivers X-rays directly to the targeted area from multiple angles, allowing for higher, more effective doses.

"Before intensity-modulated radiation therapy, we were not able to conform the dose around the chest wall," says Dr. Vallow.

For patients undergoing radiation therapy, it's crucial to stay hydrated and try to sleep well to fight fatigue. It's also important to use sunscreen after treatment.

Related Posts:

• Mayo Clinic leads 4 decades of advances in breast cancer care
• Mayo Clinic research improves dense breast cancer screening and early detection
• Top 10 questions about breast cancer answered
• Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer
• Mayo Clinic Minute: MRI for dense breasts — what to know
• Mayo Clinic Q&A: How to decide which breast cancer surgery is right for you
• (VIDEO) Back on the bench: Judge’s metastatic breast cancer journey inspires hope
• Mayo Clinic Q&A: What do you need to know about dense breasts?

The post Mayo Clinic Minute: Radiation therapy for patients with breast cancer appeared first on Mayo Clinic News Network.

Treatments such as chemotherapy, hormone therapy and immunotherapy have had limited success against advanced prostate cancer due to the tumor's ability to rewire and survive. But hope is on the horizon, thanks to a new Mayo Clinic study that uncovers how prostate cancer exploits a protein in order to resist targeted therapies and evade the immune system.

Nuclear pores are entries to the nucleus made up of proteins called nucleoporins. While nucleoporins usually stay at their post and help regulate the flow of molecules that can come in and out of the nucleus, researchers discovered that soluble POM121 — a subtype of the nucleoporin POM121 — uses its ability to navigate freely to help cancer cells grow and spread.

Dr. Veronica Rodriguez-Bravo, associate professor in the Department of Biochemistry and Molecular Biology at Mayo Clinic Comprehensive Cancer Center and senior author of the study published in Cancer Discovery, says her team's research revealed that soluble POM121, known as sPOM121, builds specialized hubs in the nucleus that rewire gene activity.

"Nobody had looked at the role of this soluble 'off-pore' nucleoporin because in gene expression analyses across databases, everything is classified under the primary nucleoporin. But through detailed analysis we saw an increase in sPOM121 in prostate cancer when compared to noncancerous tissue and a further increase in metastatic therapy resistant tumors," says Dr. Rodriguez-Bravo.

"We started digging for its purpose and found it had a distinctly relevant role in driving prostate cancer progression to lethal stages of the disease," says Dr. Rodriguez-Bravo. The study combined patient tumor analyses, molecular profiling and preclinical models to identify the protein and test its role in metastatic prostate cancer.

The study builds on her previous research, which identified POM121's key role in transporting cancer-promoting proteins into the nucleus.

'Logistic centers' that promote cancer

As a soluble protein, sPOM121 can roam freely in the nucleus, where DNA instructions are stored. "Because it's not attached to the structure that surrounds the nucleus, it can form condensates — which act like logistic centers — and bind to other proteins that regulate gene accessibility and activation," says Dr. Rodriguez-Bravo.

Most notably, sPOM121 partners with a protein called SMARCA5 that modifies DNA packaging to allow a protein called beta-catenin to enhance its expression. Beta-catenin is known to drive therapy resistance and immunosuppressing genes.

Dr. Rodriguez-Bravo says this discovery offers a possible explanation for prostate cancer growth and spread when treated with standard therapy and poor response to immunotherapy.

A potential key to treatment-resistant prostate cancer

The study tested whether blocking sPOM121-driven cancer programs like beta-catenin could improve the effectiveness of treatments such as immune checkpoint inhibitors, which help the immune system attack cancer.

"We found that targeting the soluble POM121-beta-catenin pathway really enhances the effect of immune checkpoint inhibitors. The tumors started getting a lot of T-cell infiltration and shrank," says Dr. Rodriguez-Bravo. "Beta-catenin inhibitors are currently being investigated in multiple tumor types, and our results provide the rationale to investigate the efficacy of these inhibitors alone or in combination with immunotherapy for prostate cancer."

Dr. Rodriguez-Bravo also pinpoints the strong unmet need to develop specific nucleoporin inhibitors that could target multiple cancer-driving signal pathways by disrupting these critical logistic centers. The disruption of these logistic centers by targeting sPOM121 would induce a blackout in the cancer cell, increasing the effectiveness of current therapies, but further investigation is needed to directly target sPOM121, says Dr. Rodriguez-Bravo. 

Broader impact beyond prostate cancer

Dr. Rodriguez-Bravo says this study has observed the accumulation of POM121 in multiple tumor types. Her team now hopes to investigate whether the soluble form, sPOM121, is a common cancer driver or plays an earlier role in disease progression.

"If this is really controlling fundamental pathways fueling tumor progression, targeting sPOM121 might potentially benefit more patients in the future," she says.

She also hopes the study will encourage researchers to investigate how cancer might exploit other off-pore nucleoporins.

"We believe sPOM121 is one of many other nucleoporins that orchestrate key transcriptional hubs in the depth of the nucleus. Cancer likes to have a lot of tools on its belt, so we propose these off-pore nucleoporins are selected and used efficiently during tumor evolution," says Dr. Rodriguez-Bravo. 

Review the study for a complete list of authors, disclosures and funding.

The post Mayo Clinic uncovers hidden driver fueling aggressive prostate cancer  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I just had a mammogram, and I was told that I have dense breast tissue. What does that mean?

ANSWER: About half of women are considered to have dense breasts, based on the appearance of their breast tissue on a mammogram. The main concerns about dense breast tissue are that it makes breast cancer screening more complex and increases the risk of breast cancer. Here are some answers to questions you might have:

What is dense breast tissue?

Breast tissue is composed of milk glands, milk ducts and supportive tissue, which make up dense tissue. Breasts also include fatty tissue, which is nondense tissue. When viewed on a mammogram, women with dense breasts have more dense tissue than fatty tissue.

Nondense breast tissue typically appears dark and transparent on a mammogram. In contrast, dense breast tissue appears as a solid white area, which makes it difficult to see through. 

How do doctors determine if you have dense breast tissue?

The radiologist who analyzes your mammogram determines the ratio of nondense to dense tissue and assigns a level of breast density. These levels are determined by results from the Breast Imaging Reporting and Data System from the American College of Radiology.

The levels of density are designated by letters:

• A. Breasts are almost entirely composed of fat. About 10% of women have this result.
• B. Scattered areas of density, but most breast tissue is nondense. About 40% of women have this result.
• C. Heterogeneously dense indicates some areas of nondense tissue, but most breast tissue is dense. About 40% of women have this result.
• D. Extremely dense indicates that nearly all breast tissue is dense. About 10% of women have this result.

What causes dense breast tissue?

It's not clear why some women have a lot of dense breast tissue and others don't. Dense breasts are more likely if you:

• Are younger. Your breast tissue tends to become less dense as you age, although some women may have dense breast tissue at any age.
• Have a lower body mass index. Women with less body fat are more likely to have more dense breast tissue compared with women who are obese.
• Take hormone therapy for menopause. Women who take combination hormone therapy to relieve signs and symptoms of menopause are more likely to have dense breasts.

Why does breast density matter?

Having dense breast tissue won't affect your daily life. However, it increases the chance that breast cancer may go undetected by a mammogram, since dense breast tissue can mask a potential cancer. It also increases your risk of breast cancer, though healthcare professionals aren't yet certain why.

Do screening recommendations change for dense breasts?

Women with dense breasts but no other risk factors for breast cancer are considered to have a higher risk of breast cancer than average. Dense breast tissue makes it more challenging to interpret a mammogram, since cancer and dense breast tissue both appear white on a mammogram. This may increase the risk that cancer won't be detected on a mammogram.

However, mammograms are still effective screening tools. The most common type is a digital mammogram, which is more effective at detecting cancer. It saves images of your breasts as digital files, allowing for more detailed analysis.

Are other tests more effective?

Other tests carry both risks and benefits, although MRI and molecular breast imaging have demonstrated superior cancer detection in women with dense breasts.

Supplemental tests for breast cancer screening can include:

• 3D mammogram, also known as breast tomosynthesis
  Tomosynthesis uses X-rays to collect multiple images of the breast from several angles. A computer synthesizes the images to form a 3D image of the breast. Many mammogram centers are transitioning to incorporate 3D mammograms as part of the standard mammogram technology.
• Breast MRI
  MRI uses magnets rather than radiation to create images of the breast. This option is recommended for women with a very high risk of breast cancer, such as those with genetic mutations.
• Molecular breast imaging
  This imaging uses a gamma camera to record the activity of a radioactive tracer. The tracer is injected into a vein in your arm. Normal tissue and cancerous tissue react differently to the tracer, which can be seen in the images captured by the camera.

Every test has pros and cons. Talk with your healthcare professional about your breast cancer risk factors. Together, you can decide whether additional screening tests are right for you.

Cameron Leitch, M.D., Radiology, Mayo Clinic Health System, Eau Claire, Wisconsin

Related posts:

• Mayo Clinic leads 4 decades of advances in breast cancer care
• Mayo Clinic research improves dense breast cancer screening and early detection
• Top 10 questions about breast cancer answered
• Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer
• Mayo Clinic Minute: MRI for dense breasts — what to know
• Mayo Clinic Q&A: How to decide which breast cancer surgery is right for you
• (VIDEO) Back on the bench: Judge’s metastatic breast cancer journey inspires hope

The post Mayo Clinic Q&A: What do you need to know about dense breasts? appeared first on Mayo Clinic News Network.

Judge Audrey Moran is known for her strength and fairness in the courtroom in Florida's Duval county. But one of the most difficult cases she's faced is breast cancer that spread to the lining of her brain. 

With the help of a dedicated care team and precise treatment, Judge Moran is back on the bench, and recent scans show something remarkable. Alex Osiadacz (oh-SIGH-dus) has her story.

Watch: Back on the bench: Judge's metastatic breast cancer journey inspires hope

 Journalists: Broadcast-quality video (2:17) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"I work as a county court judge."

Judge Moran doesn't shy away from a challenge, whether in her legal career, solving issues in her community or even her health.

"We were treating the metastatic breast cancer in my abdomen about two years ago now. I began noticing that my balance wasn't very good, and then I started limping," she says.

Scans in early 2024 showed the cancer had spread to the lining of her brain and spine. Treatment would pose another challenge after Judge Moran developed an infection where a port would deliver chemotherapy into the lining of her brain.

"I said, 'We're going to have to figure something else out.' My wonderful oncologist, Dr. Pooja Advani, said she thought she had an idea because a new chemo had come out that she thought might be just the right thing for me," she says.

Instead of delivering treatment directly into the lining of her brain, Judge Moran's care team was able to deliver a newly approved therapy through her arm. The results were better than expected.

"The last scan I got of my brain, the results were that the brain cancer has resolved. And I got to tell you, I couldn't even believe it when I read it on my report," Judge Moran says.

"So many emotions but the biggest of gratitude, you know, to all the people that have worked as a part of her team," says Dr. Advani.

Follow-up appointments have confirmed that the treatment is still working for the metastasis in her abdomen. Beyond her diagnosis, Judge Moran remains active with her family and career.

She says, "You know, my life is back. I am at work. And I'm getting to do that work that I love."

In late September, Dr. Advani and Judge Moran had a chance to meet again.

"It almost brought me to tears to have seen how she was in 2024 when she was going through this journey and the remarkable clinical progress that she has made," Dr. Advani says.

Judge Moran adds, "I'd gotten to the point where I almost didn't want to try anything anymore, and she really helped me realize this wasn't the time to give up. It was time to keep going. And boy, I'm glad I did. I'm really, really glad I did."

Related posts:

• Mayo Clinic leads 4 decades of advances in breast cancer care
• Mayo Clinic research improves dense breast cancer screening and early detection
• Top 10 questions about breast cancer answered
• Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer
• Mayo Clinic Minute: MRI for dense breasts — what to know
• Mayo Clinic Q&A: How to decide which breast cancer surgery is right for you

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DEAR MAYO CLINIC: I understand surgery is often included as part of the treatment plan for breast cancer. If I'm a candidate for lumpectomy but am also considering a mastectomy, what are some things I should keep in mind? Should my breast density be a factor in my decision-making?

ANSWER: Women diagnosed with breast cancer are almost immediately confronted with treatment decisions. If your surgical oncologist gave you a choice between a lumpectomy and a mastectomy to remove a tumor, that's often because either option will lead to a similar long-term health outcome.

A lumpectomy is commonly known as breast conservation surgery because it keeps most of the breast intact, whereas a mastectomy removes the entire breast. Regardless of which procedure you choose, the risk of breast cancer recurrence is roughly the same.

Lumpectomy is a treatment option for early-stage breast cancer. Compared with a mastectomy, it's less invasive and tends to have a quicker recovery. It also can help preserve the cosmetic appearance and sensation of the breast. Your healthcare professional will recommend radiation therapy after a lumpectomy to reduce the risk of breast cancer returning in the breast.

A mastectomy removes the whole breast. In many cases, radiation therapy is not needed after mastectomy. Individuals with a genetic predisposition for breast cancer, such as the BRCA1 or BRCA2 gene mutation, may opt for a mastectomy as a preventive measure following their diagnosis.

After a mastectomy, some women choose to forgo reconstructive surgery, opting for what is called an aesthetic flat closure. There can be many reasons for this, including wanting to limit future surgeries, reducing risks and complications, and desiring a faster return to daily life and activities.

For other patients, having a breast mound is part of how they identify as women. Multiple types of breast reconstruction procedures are available following either a lumpectomy or mastectomy. Breast reconstruction surgery can occur at the same time as breast cancer surgery, or you can plan your reconstruction weeks, months or years after treatment.

The surgical technique and cosmetic outcomes after mastectomy and reconstruction have improved over the past 20 years. More women can keep their nipple and areolar complex and, in many cases, a procedure can be performed to help improve sensation to the nipple and areolar complex.

Breast density also could be a factor in your decision-making. About half of people who have screening mammograms have dense breasts. Dense breast tissue is harder to see through on a mammogram image. Having dense breast tissue should not affect one's decision to undergo a mastectomy or lumpectomy.

However, dense breast tissue may influence the need for additional tests before surgery, such as an MRI. An MRI looks for abnormal blood flow within the breast and can "see through" dense tissue. This may help surgeons better determine the extent of disease and guide them in the removal.

Ultimately, determining the option that is best for you is a nuanced decision that can be based on a variety of factors, including cancer-based reasons, family history and genetics, and peace of mind. Choosing which surgical route to take is deeply personal, and there is no one "best choice" for every woman. After careful consideration and consultation with your healthcare team, you should make the decision that you determine is best for you, based on the specifics of your cancer and your individual needs and preferences. — Sarah McLaughlin, M.D., Surgical Oncology, Mayo Clinic, Jacksonville, Florida

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The post Mayo Clinic Q&A: How to decide which breast cancer surgery is right for you appeared first on Mayo Clinic News Network.