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Breast Density On Mammograms

Originally published in May 2014

Our phone triage nurses often suggest blog posts that they feel would be helpful for our patients.  I want to thank Kelly Crickmore, RN for not only coming up with this suggestion, but also for doing the research to allow me to write this!

January 1st of 2014 a new NC Law began that requires radiologists to inform all patients getting mammograms of her individual breast density.  This is why on this year’s mammogram you are seeing density for the first time!  Some version of the following paragraph will also appear on your report as required by law:

“Your mammogram indicates that you may have dense breast tissue.  Dense breast tissue is relatively common and is found in more than forty percent (40%) of women.  The presence of dense tissue may make it more difficult to detect abnormalities in the breast and may be associated with an increased risk of breast cancer.  We are providing this information to raise your awareness of this important factor and to encourage you to talk with your physician about this and other breast cancer risk factors.  Together, you can decide which screening options are right for you.  A report of your results was sent to your physician.”

What is breast density exactly?  Well, the breast is made up of fibrous, glandular, and fatty tissue.  The more fibrous and glandular tissue verses fatty tissue, the more dense the breast is.  Breast density is determined by the radiologist and there are 4 levels: fatty, scattered density, heterogeneously dense, and extremely dense. 

Breast density is important because it may increase breast cancer risk.  It also makes it more difficult to detect true abnormalities on mammogram because the density and the abnormalities can both appear “white” on the x-rays.    Despite this, mammogram is still the recommended screening tool. Adding other imaging modalities (ultrasound or MRI specifically) on a routine basis has not been proven to save lives and can sometimes show false-positive findings that are not cancer (leading to unnecessary testing and biopsies). 

Let’s run through a scenario.  Your letter says your mammogram is normal but your breasts are dense.  Should you still get mammograms?  Absolutely.  The breast density law does not affect any changes in the recommended mammogram screening guidelines.    But does this mean you are at an increased risk for cancer?  The answer is not so clear.  My understanding is that only those whose density report says “extremely dense” may be at an increased risk.  Having “extremely dense” breasts puts you at an increased risk for cancer about the same as having a close relative with breast cancer.  At your next annual examination visit you can address this with your provider to see if your lifetime risk is high enough to warrant additional testing.  As of now, there is really no other routine screening test besides mammography. 

Lastly, as many of you may know already, some of the radiology practices in town offer 3D mammogram at a slight out of pocket expense of around $50.  The quality of images and the details of the tissue allow radiologists to examine fine details of the breast tissue 1mm at a time; without the confusion of the overlapping tissue (like one would have with dense breasts).  I’ve been told that the technology is so promising that insurance companies will likely pay for this as routine in the near future.

I hope this information helps!

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