Mammograms remain one of the best ways to screen for developing cancers. However, a mammogram shows non-dense breast tissue as dark and transparent, while dense breast tissue usually appears as a solid white area, making it more difficult to see through and, therefore, to detect the possible presence of cancerous growth(s).
Dense breasts have a higher proportion of glandular tissue and fibrous tissue than fatty tissue. Note that losing weight may not necessarily affect such tissue, especially the glandular and fibrous tissue. Approximately 40% of women age 40+ have dense breasts. Why some women develop dense breasts is not presently known, but you are more likely to have dense breasts if you are a younger woman; are pregnant or breastfeeding; are taking hormone replacement therapy; and/or have a lower body weight.
While having dense breasts is considered a potential cancer risk, “Scientists don't know for sure why this is true,” says the CDC. “Breast cancer patients who have dense breasts are not more likely to die from breast cancer than patients with non-dense (fatty) breasts.”
If, however, other risk factors are present – a previous history and/or family history of breast cancer, for example – the presence of breast density may be more concerning.
In a welcome bit of news, the FDA has ruled that, effective Sept. 10, healthcare facilities providing breast imaging services are required to notify patients of their breast density in mammography reports. White Plains Hospital has long included this data in its reports, but the new ruling arguably means that now every woman receiving a mammogram will be made aware (or reminded) of the state of her breast density.
When Mammograms Are Not Enough
As noted above, a mammogram may not be sufficient in detecting possible cancer in patients with dense breasts. For those patients, a 3-D mammography is now standard of care for breast screening. This involves the creation of 3-D pictures of the breast from a series of X-rays of the inside of the breast, which can allow for more detailed analysis. It can make breast tumors or other changes in the breast (such as cysts, calcium deposits and abnormal lumps) easier to detect.
Additionally, your provider may deem it necessary to order a more advanced screening to get a better picture, including an ultrasound or an MRI.
Many patients are aware of these additional tests – in fact, even those with non-dense breasts frequently ask about receiving one of them; understandably, they want to do all they can to detect breast cancer early. However, a prevalence of false positives — where an indeterminate lesion is biopsied — can lead to needlessly increased patient anxiety and additional imaging procedures, surgical biopsies, and associated costs, which insurance and Medicare may not necessarily pay for.
The FDA directive, and White Plains Hospital’s longtime practice of including information about the density of a given patient’s breast, are both meant to supply those receiving mammograms with additional information – not to sound an alarm bell. Careful conversations with your healthcare provider about your breast density, risks for breast cancer, and your individual situation are therefore highly recommended.
To request a mammogram appointment, visit wphospital.org/mammo.
Dr. Pamela Weber is Director of Breast Imaging at White Plains Hospital. To make an appointment, call 914-336-5900.