When you had your last mammogram, did anyone tell you whether you had dense breast tissue? Did you even know to ask whether you have dense breasts? Breast density is again in the news because at least thirteen states are pushing legislation for notifications of breast tissue density as part of their mammogram reports. Connecticut, the first state to enact such legislation, also effected a law that requires insurance companies there to cover the cost of additional testing for women whose mammogram reports indicate they have dense breast tissue.
We know that digital mammography is more sensitive to dense breast tissue than analog mammography. We also know that dense breast tissue has two aspects that create risk for breast cancer.
- Dense breast tissue compromises mammography readings, most simply because density is a three-dimensional measurement while mammography measures only two dimensions. Glandular tissue in a breast shows up white on a mammogram; so does dense breast tissue. Women 40 years of age or younger have a greater tendency toward dense breast tissue. After menopause, and after pregnancy, breast tissue tends to become less dense, and thus becomes easier to read on a mammogram.
- Dense breast tissue, in itself, carries a greater risk of cancer because it contains the kinds of cells that grow, which in itself means cells that can mutate.
In the last five years or so various organizations, including the US government’s FDA, have assembled in attempts to create standardization of breast cancer density across the board. At this time radiologists apply BI-RADS (Breast Imaging-Reporting and Data System) for medical professional rating breast density into four categories from least dense to most dense. With the trend toward states’ attempting to legislate notification to patients of their breast density along with their mammogram reports, leading organizations (American College of Radiology, American Cancer Society) are working in committees to effect some standardization of classifications for breast density for the purposes of reporting same to both referring physicians and patients.
So far these states have legislation requiring mammography reports: Connecticut, Texas, Virginia and, most recently, California. As I mentioned, another thirteen other states are pursuing similar legislation. And, the FDA’s National Mammography Quality Assurance Advisory Committee (NMQAAC) addressed standardization at its 11/4/11 meeting.
What should we do ourselves? Become informed and share the knowledge. Find out whether your breast center uses digital mammography. If you receive a mammogram report with or without breast tissue density information, ask your doctor about it. If the report or your doctor indicates you have dense breast tissue, ask about further testing (usually ultrasound or breast MRI) to check further for cancer. Pursue the answer to these questions. If you cannot get answers at your current clinic, get your mammogram films and report/s and take them to another clinic for another opinion.5 6 7 8
© 2004–2012 Donna Peach. All rights reserved.