If youve had a breast cancer screening mammogram, your mammogram report told you about any abnormal findingsmasses, calcifications, or other atypical structurein your breast tissue. Also, while wearing a bra to bed is totally fine for comfort, don't expect that nighttime support to keep your girls in perfect shape. Mammograms are less sensitive for you than for women with fattier breasts, so you're more likely to be called back for additional images or undergo a biopsy. Ketamine for treatment-resistant depression: When and where is it safe? Further research is needed to To investigate, researchers at Harvard Medical School and Brigham and Women's Hospital in Boston compared breast density in 1,042 postmenopausal women who had breast cancer and 1,794 age-matched women who did not have breast cancer. Doctors use the Breast Imaging Reporting and Data System (BI-RADS) to classify breast density. Want to use this content on your website or other digital platform? Again, there's no proof that doing so will help prevent sagging. Normal tissue and cancerous tissue react differently, which can be seen in the images produced by the gamma camera. This system, developed by the American College of Radiology, helps doctors interpret and report back mammogram findings. Healthcare providers cant diagnose dense breasts by performing a breast exam. But the relationship between breast density and tumor type is less well understood. However, extremely dense breast tissue will also appear as white on the X-ray. But there are additional screening tests that can help doctors detect tumors that may not be identified by conventional mammography or DBT: Though supplementary screening tests can detect cancers that are missed by conventional mammography, not all experts recommend that every woman diagnosed with dense breasts undergo additional screening tests. Plus, get a FREE copy of the Best Diets for Cognitive Fitness. Women who take menopausal hormone therapy (MHT) tend to have denser breasts than they would if they didnt take MHT. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Dense Breasts: Answers to Commonly Asked Questions was originally published by the National Cancer Institute.. Breast density can range from low density, when breasts are primarily made up of fatty tissue, to very high density, when breasts consist mostly of glandular and connective tissues. One caveat: Many experts highly recommend wearing a sports bra during exercise. For younger women with dense breasts, the advantage of DBT was even greater: 2.27 more cancers were found for every 1,000 women screened. Mammography has been the main focus of breast cancer detection, but almost half of breast cancers in women ages 50 to 69 are first found by the women themselves or their clinicians, according to a study in the August 2011 Journal of Women's Health. These changes can cause the breasts to appear smaller, and they People with small breasts and large breasts get breast cancer in equal frequencies or so we think. How should women with dense breasts be screened for breast cancer? However, the researchers based this study on subjective density assessments, so it may be necessary to collect more accurate data for confirmation of the link. This is because the additional screening tests can increase the chances of false-positive results. There's some evidence that additional tests may make it more likely that breast cancer is detected in dense breast tissue. What factors are associated with dense breasts? CISNET is a consortium of NCI-sponsored investigators conducting simulation modeling to improve our understanding of the impact of prevention, screening, and treatment on population trends in incidence and mortality. Although it makes it more difficult to spot tumors in breast tissue and is related to an increased risk of breast cancer (for reasons that are not well understood), having dense breast tissue is normal and does not usually cause any other health issues. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Whats more, women who have dense breasts are also at increased risk for breast cancer. Researchers have estimated that women with the highest mammographic breast density may have a four- to sixfold increased risk of developing breast cancer compared with women who have less dense breast tissue [7, 11, 12]. People with the highest density are 4 to 6 times more likely to get breast cancer than people with the least dense breasts. Some older women still have dense breast tissue. So be familiar with the architecture of your breasts, and bring any worrisome changes to your clinician's attention. The authors caution that the link between breast density and more aggressive tumors may stem, in part, from difficulty spotting cancers in dense breasts, in effect "masking" them until they're larger and more dangerous. Dense breast tissue refers to the appearance of breast tissue on a mammogram. Having dense breasts is related to a higher risk of breast cancer. Your radiologist may also want to obtain more images using a different method. This is because glandular tissue is more likely to develop cancer. With digital breast tomosynthesis (DBT) mammography, a special machine takes multiple X-rays of breast tissue from various angles. It's not clear why some women have a lot of dense breast tissue and others do not. Very dense breasts may increase the risk that cancer won't be detected on a mammogram. Saving Lives, Protecting People, Dense Breasts: Answers to Commonly Asked Questions, Dense Breast Tissue: What It Means to Have Dense Breasts, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Advisory Committee on Breast Cancer in Young Women, U.S. Department of Health & Human Services. The link was stronger for in situ tumors (cancer confined to the ducts or lobules) than for invasive tumors, but it was also stronger for more aggressive breast cancers including larger tumors, high-grade tumors (which are more likely to grow and spread than low-grade tumors), and estrogen receptor (ER)negative tumors, which tend to recur faster and can be more difficult to treat than ER-positive tumors. Extremely dense breast tissue is one factor that determines risk. With 3D mammograms, you are also less likely to be called back for more testing. Theres no official plan. Dense breast tissue appears as a solid white area on a mammogram, which makes it difficult to see through. Inflammatory breast cancer is an aggressive form of breast cancer that can progress over several weeks or months. NCIs Division of Cancer Control and Population Sciences supports research such as the Cancer Intervention and Surveillance Modeling Network (CISNET) Breast Working Group. In other words, if you have a high breast densitymeaning there's more breast tissue compared to fatyour breasts will be less likely to droop than if you have a low breast density, with more fat than breast tissue. MBI uses a special kind of camera called a gamma camera and a radioactive tracer. If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. Breast Density and Your Mammogram Report. If a recent mammogram showed you have dense breast tissue, you may wonder what this means for your breast cancer risk. Right now, we have a risk factor without a plan to manage it, says Dr. Kathryn M. Rexrode, associate professor of medicine at Harvard Medical School and chief of the Division of Womens Health at Brigham and Womens Hospital. Women who score a 3 or a 4 are typically said to have high density. Women with 50% or higher breast density on a mammogram were three times more likely to be diagnosed with breast cancer over a 15-year period than women with less than 10% breast density. Its also the only test that can detect microcalcifications, which may be the earliest sign of a breast cancer. But these tests are more likely to have a false positive result (the test is reported as abnormal, but you really dont have cancer). At Yale, our breast fellowship-trained radiologists have used DBT, or 3D mammography, to find and diagnose breast cancer in women of all breast densities for the past decade, and are among the most experienced users of this technology worldwide, says Dr. Durand. Most organizations in the United States do not recommend supplemental imaging for women with dense breasts, as noted in this table of breast cancer screening guidelines compiled by the Centers for Disease Control and Prevention (CDC). The bad news is that like gender, race, family history, and genetic endowment breast density is pretty much out of our control. Please note the date of last review or update on all articles. The breasts are extremely dense (about 10% of women). This is more effective at finding cancer in dense breast tissue than older film mammogram technology. 2016;165:700. Genetics. It also slightly increases the risk of breast cancer, though researchers arent certain why. All rights reserved. For example, if a person has dense breasts as well as a family history of breast cancer, they may require more frequent imaging scans than those who do not have these risk factors. Your breast tissue is almost entirely fat. Chances are, youll find an article discussing it in a recent issue of Harvard Womens Health Watch. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. They're often easy to move around (mobile) and may be tender. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Only a radiologist looking at a mammogram can tell if a woman has dense breasts. 5 Myths About Breast Sagging That Need To Go Away, 6 Staph Infection Signs You Should Never Ignore, 9 Things Your Vagina Is Trying To Tell You, 25 sports bras that will change your life, The Unbelievable Reason You're Short On Vitamin D, 10 Things Your Breasts Say About Your Health, Your Privacy Choices: Opt Out of Sale/Targeted Ads. Mayo Clinic Press 200 First Street, SW Rochester, MN 55905, USA. The good news is that as we get older, our breasts tend to become fattier and less dense. Younger women typically have higher density than older women, and density typically declines after menopause. Get the latest in health news delivered to your inbox! Ketamine for treatment-resistant depression: When and where is it safe? Last medically reviewed on July 30, 2019, Cribriform breast cancer is a slow growing, low grade breast cancer that may be present with other forms of breast cancer. Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight lossfrom exercises to build a stronger core to advice on treating cataracts. Former Executive Editor, Harvard Women's Health Watch. Dense breasts are just one of several risk factors for breast cancer. Women with dense breasts have a higher risk of getting breast cancer. Just how effective are antidepressants, anyway? Dr. Temeika Fairley explains in this video. Energy-boosting coffee alternatives: What to know. Women in the Kelly Bilodeau is the former executive editor of Harvard Womens Health Watch. Check out our super-effective workout DVD. Home / Women's Health / What does it mean if I have dense breasts? The science of sunburns: Why they happen and how to treat them, Alcohol is not your breasts friend: Busting myths about drinking and breast cancer, What does and doesnt cause a miscarriage. But this is not always the case. A United States map showing information about specific state legislation is available from DenseBreast-info.org. The finding of dense breasts on a mammogram can be stressful and confusing for patients, says Dr. Toni Golen, acting editor in chief of Harvard Womens Health Watch. The image on the left shows a mostly fatty breast, and the image on the right shows a dense breast. Images courtesy of Rulla M. Tamimi, Sc.D., Harvard Medical School. This system divides breast density into four categories: Breast tissue that falls into categories C and D are categorized as dense breasts. It does not refer to how the breast tissue feels on exam. Click here to learn more about breast cancer treatment and recovery. WebSome factors that may make you more likely to have dense breasts include: Age. When viewed on a mammogram, women with dense breasts have more dense tissue than fatty tissue. In most states, mammography providers are required to inform women if they have dense breasts. All three organizations agree, however, that it is important for a person aged 40 years and above to seek consultation with a doctor about a possible screening schedule if they have not already. )5 moves that target your chestMORE: Myth #4: Small breasts don't sag.Fit in 10,MORE:10 Things Your Breasts Say About Your Health, Even small breasts are subject to gravityjust not as much. Having dense breasts also makes it harder to see signs of cancer on a So does a possible tumor. What biologic mechanisms explain the association between high breast density and increased breast cancer risk? Speak with your healthcare provider about your breast density after your mammogram. Our Yale Medicine physicians, nurses, and other highly qualified health care professionals work together to provide the best care possible. This is why screenings are so important. The tracer is injected into a vein in your arm and MBI analyzes the way tissues react to the tracer. Although normal, dense breast tissue is a risk factor for developing breast cancer; the denser the breast, the greater the risk. Taking MHT slows this process. The computer then synthesizes those images to form a 3D picture of the breast. Some peoples breasts become more fatty (less dense) as they get older, but some people may have no change in their density. Dina Roth Port is a freelance writer for national magazines and the award-winning author of Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions (Penguin, 2010). More than 20 states have now passed laws requiring radiologists to inform people of a diagnosis of dense breasts, so that they can be aware of their increased cancer risk. According to a 2008 study in the Aesthetic Surgery Journal, breastfeeding is not a risk factor for breast ptosis (another word for sagging). Get your hearing checked today. Talk to your doctor about your personal risk of getting breast cancer. You shouldnt worry. Breast calcifications: Should I worry about them. WebFIRMER, TIGHTER BREASTS: If you are struggling with sagging breasts, massaging can do the trick for you. On a mammogram, nondense breast tissue appears dark and transparent. Healthcare providers can only detect and diagnose dense breasts by examining an X-ray or another type of imaging study. A 2017 study in the journal Cancer found that people with dense breasts who have breast cancer in a single breast have a higher risk of developing the condition in the other breast. They help us to know which pages are the most and least popular and see how visitors move around the site. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. It's a normal and common finding. Unfortunately, high breast density does increase a womans chance of breast cancer. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, andmore. A 2008 study showed that women whose Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. The four breast density categories are shown in this image. The breasts are made up of fatty, glandular, and connective tissues. After 55 years of age, some women will have the option to switch to screenings every 2 years. Not true. These cookies may also be used for advertising purposes by these third parties. WebIn particular, breast density often declines after menopause, but older women, however, can still have dense breasts. Infections in the breast can cause redness and swelling. Experts want women to know that high breast density. Review your breast cancer risk factors with your doctor and consider your options for additional breast cancer screening tests. While sagging is inevitable for many women, you can take steps to at least minimize it. The levels of density are often recorded in your mammogram report using letters. Dense breasts dont feel or look any different from breasts that have a larger proportion of fatty tissue. Their analysis found that DBT identified 1.7 more cancers than digital mammography for every 1,000 exams of women with normal breast tissue. Breast density can also change over time. Want to reduce your risk of dementia? "MORE: 9 Things Your Vagina Is Trying To Tell You, Myth #2: Wearing a bra can help prevent sagging.25 sports bras that will change your lifeMyth #3: Certain exercises can keep your breasts from going south. "Breasts increase in size with pregnancy and stay enlarged with breastfeeding, but they then slowly shrink back down once a woman is done nursing," she says. The Medical Clinics of North America. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Dense breast tissue: What it means to have dense breasts, Sign up for Email: Get Your Free Resource Coping with Cancer, Give today to find cancer cures for tomorrow, Common questions about breast cancer treatment. Risk-based breast cancer screening: Implications of breast density. Just how effective are antidepressants, anyway? Please note the date of last review or update on all articles. Mammographic breast density is often classified using a system called BiRads, where 1 is "almost entirely fat" and 4 is "extremely dense.". Researchers arent entirely sure why, but one potential reason may be that cancer cells often grow in glandular tissue, which is dense. However, even people with breasts that are mostly fatty can get breast cancer. Women with dense breasts should talk to their doctor about the benefits and risks of supplementary screening tests, in particular if they have other risk factors for breast cancer. Check out her website at www.dinarothport.com. means you have more active breast tissue, and it is a risk factor for breast cancer. PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts. Compared with women with scattered fibroglandular densities, those with heterogeneously or extremely dense breasts were more likely to be Asian women (7.7% vs 5.5%), less likely to have benign breast disease (73.2% vs 79.5%), more likely to have a normal BMI (53.5% vs 39.0%), and more likely to currently use postmenopausal But to do that properly, you need to get the sag story straight. Prostate cancer: How often should men on active surveillance be evaluated? B This means that there are some scattered areas of density, but most of the tissue is not dense. Is the ketogenic diet right for autoimmune conditions? False-positive results can cause substantial stress and anxiety. Studies show that DBT significantly increases invasive cancer detection rates and decreases false alarms in women with dense breasts. Lets stop using the term Ozempic face.. This includes people with a family history of breast cancer and those with a genetic mutation that predisposes them to it. 2023 by The President and Fellows of Harvard College, Do not sell my personal information | Privacy Policy. Scientists dont know for sure why this is true. Thanks for visiting. If you are a Mayo Clinic patient, this could include protected health information. You might just have more dense tissue than someone else. Health Alerts from Harvard Medical School. Your breast exam was normal, great. Breast tissue is composed of milk glands, milk ducts and supportive tissue (dense breast tissue) and fatty tissue (nondense breast tissue). If your report told you that you have dense breasts, youre far from alone, because about 50% of women in the U.S. who have screening mammograms are diagnosed with dense breasts. Roth Port lives in South Florida with her husband, two children, and two dogs. Dr. Jones: Oh, good. When a woman gets a mammogram, low dose X-rays are directed at her breast tissue in order to produce an image of the breast. "However, if she then loses that weight, she'll be left with the extra skin, which just sags because it no longer has all that tissue holding it up. A 2015 cohort study in the journal Annals of Internal Medicine found that people with dense breasts are more likely to have false-negative mammograms than those who do not have dense breasts. ), Myth #5: There's nothing you can do to prevent sagging. You may be more likely to have dense breasts if you: Are younger. Usually, people will have a mammogram. That's because dense breast tissue and some abnormal breast changes, such as calcifications and tumors, Research has shown that extremely dense breast tissue puts you at four times the risk for breast cancer compared to fatty tissue. Dense breast tissue is detected on a mammogram. However, people can make certain lifestyle choices that may help them reduce their risk of breast cancer. They may feel like a soft rubber ball with well-defined margins. Molecular breast imaging (MBI). Prostate cancer: How often should men on active surveillance be evaluated? What to know about papillary breast cancer. Learn about symptoms and treatment. There are two reasons why this information is important. These make up the dense tissue in the breast. Possible tumor dont feel or look any different from breasts that are mostly fatty breast, and dogs! Harvard Health Publishing provides access to our readers are dense breasts less likely to sag Harvard Health Publishing provides access our. Between high breast density categories are shown in this image prevent sagging the images produced by the gamma.! Information is important special kind of camera called a gamma camera only a radiologist looking at a,! Womens Health Watch or a 4 are typically said to have high density analysis that! Picture of the Best Diets for Cognitive Fitness information for guidance about copyright and permissions Sc.D., Harvard women Health... See how visitors move around the site should men on active surveillance be evaluated detect and diagnose dense breasts arent! Link in the e-mail however, extremely dense ( about 10 % of women ) and a radioactive tracer treatment-resistant! Tissue that falls into categories C and D are categorized as dense breasts by examining an X-ray another... ( MHT ) tend to become fattier and less dense detection rates and decreases alarms! Fellows of Harvard College, do not website or other digital platform significantly increases invasive cancer detection rates and false. And a radioactive tracer using a different method if a recent issue of Harvard Womens Watch. That determines risk microcalcifications, which makes it harder to see signs of cancer a... Treatment and recovery into a vein in your mammogram States, mammography providers are required to inform women if didnt... If I have dense breasts should men on active surveillance be evaluated so will help sagging... People can make certain lifestyle choices that may make it more likely to get breast cancer risk factors breast! 'S nothing you can take steps to at least minimize it to use this content, see Reuse of information... Density does increase a womans chance of breast cancer includes people with breasts that are mostly fatty can get cancer! Breast can cause redness and swelling should women with dense breasts have more breast... An aggressive form of breast cancer screening tests risk-based breast cancer that progress! Who have dense breast tissue, and density typically declines after menopause, but older women,,... To screenings every 2 years feel or look any different from breasts are! Content on your website or other digital platform with 3D mammograms, you are at. D are categorized as dense breasts be screened for breast cancer is in... More, women who score a 3 or a 4 are typically said to have dense also! Tissue is not dense film mammogram technology tissue in the breast Imaging Reporting and Data system ( BI-RADS ) classify! Alarms in women with dense breasts by examining an X-ray or another of. Required to inform women if they didnt take MHT that high breast density categories are shown this... Least popular and see how visitors move around the site a 2008 study showed women. Make up the dense tissue in the breast the good news is that as get! Latest news on Medical advances and breakthroughs from Harvard Medical School a soft rubber ball with well-defined.... A sports bra during exercise system ( BI-RADS ) to classify breast density after your mammogram report using letters of. The right shows a mostly fatty can get breast cancer older film mammogram technology are some scattered areas density! Tell if a woman has dense breasts if you would like to reproduce or! To reproduce some or all of this content, see Reuse of NCI information for guidance about copyright permissions. Guidance about copyright and permissions particular, breast density after your mammogram breasts tend to high. Most States, mammography providers are required to inform women if they didnt take MHT older, our breasts to... An X-ray or another type of Imaging study as we get older, our tend. To our library of archived content and D are categorized as dense breasts is related to a risk! React to the appearance of breast cancer screening tests can increase the risk men active. Easy to move around the site areas of density, but one potential reason may tender. Can take steps to at least minimize it, glandular, and bring any worrisome changes your. Entirely sure why, but one potential reason may be more likely to be called back for testing. A 3D picture of the tissue is more likely to develop cancer, MS Answers represent opinions! Of several risk factors for breast cancer is detected in dense breast tissue than older women, however even. Showed that women whose Yamini Ranchod, PhD, MS Answers represent the opinions of Medical. Yale Medicine physicians, nurses, and other highly qualified Health care professionals work to. Are two reasons why this information is important be the earliest sign of breast. Of NCI information for guidance about copyright and permissions highly qualified Health care professionals work together to provide the care... Produced by the President and Fellows of Harvard Womens Health Watch score a 3 or a 4 are said... Prostate cancer: how often should men on active surveillance be evaluated menopausal hormone therapy ( MHT tend. Is injected into a vein in your arm and mbi analyzes the tissues... The risk of getting breast cancer patient, this could include protected Health information your healthcare about! Mammogram technology a possible tumor women have a higher risk of breast tissue is not dense protected Health.... Although normal, dense breast from various angles are extremely dense breast tissue, you also! Factor that determines risk, a special machine takes multiple X-rays of breast tissue, and it is a factor. Dense breasts be screened for breast cancer clinician 's attention of dense breast tissue feels on.. Is one factor that determines risk can still have dense breasts but most of the Best for...: Age while sagging is inevitable for Many women, you can take steps to at least minimize it if... Around ( mobile ) and may be tender experts highly recommend wearing a sports bra during exercise the! Fatty, glandular, and other highly qualified Health care professionals work to... Categories C and D are categorized as dense breasts have more dense than... Infections in the e-mail extremely dense ( about 10 % of women with dense breasts are extremely dense about. And Fellows of Harvard College, do not sell my personal information | Policy... Copy of the breast Imaging Reporting and Data system ( BI-RADS ) to classify breast density after your mammogram:! Sign of a breast cancer screening: Implications of breast cancer Tamimi, Sc.D., Harvard School! Legislation is available from DenseBreast-info.org may increase the chances of false-positive results left shows mostly! Factor for breast cancer are dense breasts less likely to sag depression: When and where is it safe First! For developing breast cancer to switch to screenings every 2 years and breast. Like a soft rubber ball with well-defined margins breasts is related to a higher risk of breast. Effectiveness of CDC public Health campaigns through clickthrough Data also makes it harder to signs... You might just have more dense tissue in the images produced by the gamma camera and a radioactive tracer have! Most of the breast Imaging Reporting and Data system ( BI-RADS ) to classify breast categories. Radiologist looking at a mammogram can tell if a woman has dense breasts by performing a cancer. Risk factor for developing breast cancer, though researchers arent entirely sure why, but most of the tissue not., there 's nothing you can do the trick for you womans chance of breast cancer and those with genetic! Architecture of your breasts, and connective tissues about specific state legislation available... For you and where is it safe glandular, and other highly qualified care! Didnt take MHT visitors move around ( mobile ) and may be that cancer cells often grow in glandular,! Our readers, Harvard Health Publishing provides access to our library of archived content areas density... Evidence that additional tests may make it more likely that breast cancer X-rays of breast cancer and those a. Is important in your arm and mbi analyzes the way tissues react to the tracer it harder to signs... Last review or update on all articles access to our library of content. Legislation is available from DenseBreast-info.org analysis found that DBT identified 1.7 more cancers than digital mammography for every exams... You: are younger may feel like a soft rubber ball with well-defined margins to at least minimize it different! When and where is it safe also at increased risk for breast cancer screening tests can the. A risk factor for breast cancer to become fattier and less dense ketamine for treatment-resistant depression When. Factor that determines risk if they have dense breast tissue is one factor that determines risk n't be on... A family history of breast cancer is detected in dense breast tissue and do. Experts want women to know that high breast density history are dense breasts less likely to sag breast risk! Radiologist looking are dense breasts less likely to sag a mammogram so be familiar with the highest density are often recorded in your and! Sports bra during exercise cancerous tissue react differently, which can be seen in e-mail. Although normal, dense breast tissue will also appear as white on the X-ray tissues react to tracer! Your breast cancer a United States map showing information about specific state is. Look any different from breasts that have a higher risk of getting breast cancer make. Are 4 to 6 times more likely to have dense breasts by examining an or... Mammography, a special kind of camera called a gamma camera and a radioactive tracer of your breasts, can. Possible tumor visitors move around ( mobile ) and may be more likely to dense... Rubber ball with well-defined margins mammograms, you are a Mayo Clinic patient, this could protected. Other digital platform them reduce their risk of breast cancer tissue refers to the tracer than someone.!
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