How to Reduce Breast
Density to Decrease
Risk of Breast Cancer
by Sat Dharam Kaur ND
Breast Density and
Cancer Risk
• Increased breast density causes a 4-5 fold
greater risk of breast cancer in women who
have increased density in > 75% of breast
tissue
• 1/3 of all breast cancers are found in women
who have increased density in > 50% of their
breast tissue Lancet Oncol. 2005 Oct;6(10):798-808
Breast Density and
Cancer Risk
• 43.3% of US women ages 40 to 74 years
of age have heterogeneously or extremely
dense breasts (about 27.6 million women) as
determined by mammography
• Breast density is inversely associated
with age and BMI
• Women aged 40 to 49 years account for 44.3%
of this group
J Natl Cancer Inst. 2014 Sep 12;106(10)
Detecting Increased
Breast Density
Breast density can be evaluated using:
• Mammography
• MRI
PLoS One. 2014;9(6): e99027
• Ultrasound
AJR. Jul 2012; 199(1):224-235.
• Skilled Clinical Breast Exam - may not match
mammographic exam - high and low densities were
detected in 84.5% and 15.5% of clinical breast examinations
and 59.7% and 40.3% of mammographies, respectively.
There was a significant difference between breast tissue
densities in breast examination with those in
mammography Asian Pac J Cancer Prev. 2013;14(6):3685-8
Detecting Increased
Breast Density
• Breast tissue is composed of fat, glandular
tissue and fibrous tissue
• Fat is radiolucent and appears dark on a
mammogram; glandular and fibrous tissue are
radiodense and appear light.
• When more glandular and fibrous tissue are
present, breast density is greater
Grading Breast Density
• the American College of Radiology developed a
Mammography Breast Imaging Reporting and
Data System scoring method using a 1-4 rating
• BI-RADS 1:
less than 25% Dense Breast Tissue
• BI-RADS 2:
26-50% Dense Breast Tissue
• BI-RADS 3:
51-75% Dense Breast Tissue
• BI-RADS 4: more than 75% Dense Breast Tissue
Breast Density Comparison
Age and Breast Density
• ¾ of women in their 30’s have increased breast
density
• ¼ of women in their 70’s have increased breast
density
• Mammographic breast density can diminish over
time
• Women whose breast density does not diminish
over time are more likely to be diagnosed with
breast cancer
Int J Cancer. 2104 Oct 1;135(7):1740-4
Causes of Increased
Breast Density
• Genetic
• Lifestyle
• Neonatal
• Dietary
• Reproductive
• Nutritional
• Hormonal
• Environmental
Genetic Factors
• density is influenced by age, parity, body mass
index and menopause, but these factors account
for only 20-30% of the variation in density
• twin studies show that mammographic density is
highly heritable – inherited factors explain 63% of
the variance Methods Mol Biol 2009;472:343-60
• Ashkenazi Jews have  breast density compared
to other Caucasians Breast Cancer Res 2013 May 13;15(3)
Neonatal Factors
• higher birth weight (>4000 grams or 8 lb, 13 oz )
is correlated with premenopausal breast cancer,
in comparison to lower birth weight (<2500
grams or 5 lb, 8 oz) Lancet. 1996 Dec 7;348(9041):1542-6.
Hormonal Factors
• increased estradiol, estrone, IGF-1, prolactin
• use of birth control pill
• use of hormone replacement therapy
• increased weight gain in adulthood
Menstrual and
Reproductive Factors
• earlier age at onset of menstruation (<11 yrs
old)
• shorter menstrual cycle length (< 25 days)
• later age at menopause (>53 years)
• premenopausal women have increased density
compared to postmenopausal women
• prior benign breast disease
Menstrual and
Reproductive Factors
• parity (not having children) is significantly
inversely associated with breast density
• mean percent dense breast volume (%DBV)
decreases from 20.5 % in nulliparous women to
16.0 % in parous women.
• breast density is inversely associated with
the age women start using hormonal
contraceptives
Menstrual and
Reproductive Factors
• breast density increases the longer hormonal
contraceptives are used
• mean %DBV decreases from 21.7 % in women who start
using hormones at 12-17 years of age to 14.7 % in those
who start using hormones at 22-28 years of age
• age at which women started using hormonal
contraceptives and duration of hormone use are
inversely correlated
• mean %DBV increased from 15.8 % in women who used
hormones for not more than 2.0 years to 22.0 % in
women who used hormones for more than 8 years
Dietary Factors
• increased red meat consumption, particularly
in adolescence
• alcohol consumption
• saturated fats (meat, butter, ice cream)
• high glycemic load, from simple sugars and
refined carbohydrates
Breast Density and Sweets
BMC Public Health. 2014 Jun 26;14:554
Environmental Factors
• Postmenopausal women with high serum
levels of Bisphenol A (BPA) and mono-ethyl
phthalate had elevated breast density
Breast Cancer Res. 2013 may 27;15(3):R45
Ways to Reduce Breast
Density and Cancer Risk
• have a child before age 24
• have three or more children
• breastfeed
Dietary
Recommendations
• Decrease or eliminate red meat, transition towards a
plant-based diet
• Decrease saturated fat (meat, butter, ice cream, fatty
cheese)
• Decrease sugar, refined carbohydrates and high
glycemic carbohydrates
• Avoid alcohol or limit to less than 3 alcoholic
beverages per week
• Eliminate caffeine
• Decrease caloric intake
Consume Daily
• increase fiber to 45 mg/day - use chia, flax, legumes,
psyllium, rice bran, wheat bran if tolerated
• use 2 or more Tbsp freshly ground flaxseed
• eat 1-2 cups of legumes daily (bean soup, bean dip,
bean and grain casserole)
• eat 6 servings of vegetables daily (2 cups salad, 2 cups
steamed vegetables)
• eat vegetables containing carotenoids (carrots,
squash, sweet potato)
Consume Daily
• eat 2 Tbsp or 3000 mg of linolenic acid from flax
and/or fish oil . Pour flaxseed oil over rice, pasta,
baked potato; add to salad dressing, use in
smoothies. Never heat it. Keep refrigerated.
• use 1 Tbsp olive oil daily in salad dressing
• use ½ cup organic tofu or 1 glass soymilk daily, or
both. Avoid if allergic.
• drink green tea or take a green tea supplement
• use rosemary as a spice and as tea
Nutritional Factors to
Decrease Breast Density
• vitamin D >1750 IU/day
• calcium >700 mg/day
Other Nutritional Factors
to Prevent Breast Cancer
• inositol and alpha lipoic acid
• curcumin
• rosemary
• N-acetyl cysteine
• Coenzyme Q10
• Green tea extract
• Grape seed extract
Other Nutritional Factors
to Prevent Breast Cancer
• B complex
• magnesium
• kelp
• indole-3-carbinol
• tocotrienols
Lifestyle Factors to
Decrease Breast Density
• Exercise 40 minutes a day
• Spend more lifetime hours in the sun
• Avoid weight gain during adulthood and after
menopause
• Avoid birth control pill and hormone replacement
therapy
• Avoid plastics containing bisphenol-A and phthalates,
especially during pregnancy
• Use organically grown food as often as possible