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Having dense breasts puts women at a higher risk for breast cancer and makes it harder to detect cancer on a mammogram, but many don't realize it's a big risk.
Starting this week, all mammography reports and results letters sent to patients in the United States must include a breast density assessment. US Food and Drug Administration Final rule A requirement for mammography facilities to inform patients about their breast thickness will go into effect on Tuesday.
Breast density is a measure of how much fibroglandular tissue and fatty tissue is in a woman's breast. The more fibroglandular tissue, the denser the breast.
About half of all women over 40 in the United States have dense breast tissue, according to a radiologist. Dr. Kimberly FaginInterim Chief of Breast Imaging Services and Head of Breast Imaging Quality Assurance at Memorial Sloan Kettering Cancer Center.
“We talk about breast density for two reasons. One is that breast density makes it more difficult to detect cancer on a mammogram.
In other words, dense breast tissue can hide cancer on a mammogram because the tissue appears white on a mammogram, the same way lumps and tumors appear.
“The second reason breast density is important is because having dense breast tissue increases a woman's risk of developing breast cancer,” Feagin said.
The new notification requirements do not provide specific next steps for patients with dense breasts, but recommend that women have a clear understanding of their individual risks and talk with their providers to determine the screening plan that is right for them.
While all women are recommended to have a mammogram starting at age 40, some women with denser breasts may benefit. Additional imaging options for breast examinationssuch as ultrasound or MRI.
Breast cancer survivor Joanne Pushkin, 64, has been advocating for a national requirement for more than a decade to require women to disclose their breast density. She said the new rule has been a long time coming.
In the mid-40s, Pushkin noticed a lump on her breast, but was not particularly worried; She had a routine mammogram eight weeks ago.
But she still went back for a diagnostic mammogram, and radiology technologist Pushkin told them, “We didn't see anything.”
Pushkin thought that the technologist mistook her for another patient.
“It was a big facility with a lot of waiting rooms, and I thought she was going back to the wrong room,” Pushkin said. “Oh no, I'm a swell girl I can feel. She said to me: 'Oh, you have thick breasts. That's going to be a very difficult search for us,' and I sat down and said, 'Wait, what?' I remember telling her. I didn't even know how to understand this sentence.
Although Pushkin's mammogram at the time did not reveal the lump she felt, she did further testing and ultrasounded her breast.
“And there was a swelling as clear as a bell,” said Pushkin. “It was determined to be breast cancer. Within 20 minutes, I found out that I had dense breasts, I found out that I had breast cancer, and I found out that because I had dense breasts, I missed it.”
Pushkin says her disease is at an advanced stage, and she has undergone eight surgeries and eight rounds of chemo as part of her treatment.
“A few years later, I had a relapse, and then I had 30 rounds of radiation. Now I have lymphedema, and it's all because it was diagnosed at a later stage,” said Pushkin, who testified for the FDA about breast density and co-created the website. DenseBreast-info.orgThis shows resources on breast density.
“I feel like I was denied an early diagnosis because I wasn't told I had dense breasts.”
Routine for everyone who gets a mammogram
so far, Approximately 39 states and the District of Columbia. According to a tracker on the DenseBreast-Info website, predetermined breast density information is required to be reported to patients in mammogram results letters. But the language in each state can vary and providers don't always want to inform patients of their risks, which is why advocates have pushed for a national standard.
With the new FDA rule in effect, informing patients about their breast density will be blanket coverage nationwide.
“This now provides a uniform national standard for women in all states to be told whether their breasts are dense or non-dense when they have a mammogram,” said Dr. Wendy Berg, professor of radiology. He served as the Chief Scientific Advisor for DenseBreast-info.org at the School of Medicine of Pittsburgh and McGee-Women's Hospital of UPMC.
The new FDA changes require facilities to provide information to patients about their breast density and include specific language on mammogram results letters to explain how breast density affects the accuracy of mammograms.
Example a Notice statement It can be: “Breast tissue can be dense or non-dense. Dense tissue makes it harder to find breast cancer on a mammogram and increases the risk of developing breast cancer. Breast tissue is dense. In some cases of dense tissue, other imaging tests besides mammograms can help find cancer. Talk to your health care provider about breast density, your risk for breast cancer, and your individual situation.
Or the statement might be: “Breast tissue is not dense or dense.” Dense tissue makes it harder to find breast cancer on a mammogram and increases the risk of developing breast cancer. Breast tissue is not dense. Talk to your health care provider about breast density, your risk for breast cancer, and your individual situation.
Understanding breast density
There are four types of breast density on a mammogram report, ranging from dense to very dense, Berg said.
With mostly thick breasts, “cancer is much easier to spot, and these women are much less likely to develop breast cancer.” It will be the next category Diffuse fibroglandular densityBerg is very common.
“And then there's a variety of dense that can obscure the masses – at least 25% of cancers fall into this category,” she said. “And then very dense is the last category where at least 40% of cancers are lost. And, if you compare a woman with very dense breasts to someone with normal breasts, she's four times more likely to get breast cancer.”
10 years ago, Berg said, based on her own family history of breast cancer and breast density, she determined her risk of developing the disease was 19.7%. Because of this, she told her own doctor to do a breast MRI instead of just a 3D mammogram.
“The MRI showed a small invasive cancer that you wouldn't see on my own mammogram,” said Berg, who has been treated for the disease.
“After that experience, I said there should be a place to tell women that they have dense breasts, if women qualify for an MRI or if they want to have an ultrasound and what. Protect from these challenges, “said Berg.
of FDA notes In some people with dense breast tissue, other imaging tests besides mammograms can help find cancer.
“But he won't say more than that. And then it ends with 'talking to your health care provider,'” Berg said. “The guidelines are not as clear as they could be.”
Many women may not know to ask for additional imaging, such as an MRI, or their doctor may not agree that they are needed in some cases. Also, for some cases, these options are not covered by insurance.
“Knowledge is power, and all women can now have conversations with their healthcare providers about the screening plan that's right for them, based on factors that affect their personal breast cancer risk, including breast density,” Molly Guthrie, vice president of policy and advocacy at Susan G. Komen, said in a statement.
“We want everyone to know that just dense breast tissue doesn't need more imaging—that's one reason for breast cancer risk,” Guthrie added. “Out-of-pocket costs are often a barrier for those who need imaging beyond mammograms. That is why we have been advocating for state and federal legislation to eliminate these costs. We have the technology to detect breast cancer early and save lives, financial barriers should not be a barrier. It's important for people to understand the breast shape they need based on their individual risk and find it at an affordable price.
The American Cancer Society has praised the FDA's new rule, saying it will reduce delays in testing. It is supposed to be about. 1 out of 8 women will get breast cancer during her lifetime.
“The final rule improves screening by addressing new technologies, better implementing institutional accreditation and quality standards, and improving reporting to women and their physicians.” ACS said in a statement. last year.
The ACS said at the time that while the new changes have helped reduce breast cancer death rates, more work needs to be done to ensure all women have access to high-quality mammograms.
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According to the organization, “Black women are more likely to receive low-quality screenings, contributing to this continuous differenceBreast cancer mortality among black and white women.
A Research In the year Published in 2022, breast cancer deaths fell by 43% in the three decades from 1989 to 2020, translating to 460,000 fewer breast cancer deaths over that period. When the data was analyzed by race, black women had lower rates of breast cancer than white women, but the overall death rate was 40 percent higher for black women.
“Either it is important to check or not. And if it matters, it's very important for women who we know are at high risk and mammograms are a vulnerable tool,” Pushkin said. “Notifying…