Breast density is a measurement of how much fibroglandular tissue there is in a woman’s breast versus fatty tissue.
“The second reason that breast density is important is because having dense breast tissue raises a woman’s level of risk of developing breast cancer,” Feigin said.
Breast cancer survivor JoAnn Pushkin, 64, has advocated for more than a decade that there be a national requirement for women to be notified of their breast density.
Now I have lymphedema, and all because it was detected at that later stage,” said Pushkin, who has testified before the FDA about breast density and co-created the website DenseBreast-info.org, which features resources on breast density.
The new FDA changes require facilities to provide patients with information about their breast density and include specific language in the mammogram result letter to explain how breast density can influence the accuracy of a mammogram.
Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer.
Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation.” Or a statement could be: “Breast tissue can be either dense or not dense.
Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer.
Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation.” Understanding breast density There are four categories of breast density provided on a mammogram report, ranging from mostly fatty to extremely dense, Berg said.
A study published in 2022 found that the breast cancer death rate dropped by 43% within three decades, from 1989 to 2020, translating to 460,000 fewer breast cancer deaths during that time.
Many women are unaware of the substantial risk associated with having dense breasts, which can increase their chance of developing breast cancer and make it harder to detect the disease on a mammography.
As of this week, an evaluation of breast density will be included in all mammography reports and result letters that are sent to patients in the US. Tuesday marks the implementation of the US Food and Drug Administration’s final rule mandating that mammography facilities disclose to patients their breast density.
The ratio of fibroglandular to fatty tissue in a woman’s breast is measured as her breast density. The denser the breast, the more fibroglandular tissue.
Radiologist Dr. Kimberly Feigin, interim chief of the Breast Imaging Service and head of the Breast Imaging Quality Assurance at Memorial Sloan Kettering Cancer Center, estimates that about half of American women over 40 have dense breast tissue.
There are two reasons why we discuss breast density. According to Feigin, one reason breast density may make it more challenging to detect cancer on a mammography is that white-looking dense breast tissue, which includes glandular and connective tissue-supporting elements, can be mistaken for cancer.
Put another way, because dense breast tissue appears white on a mammography, similar to how lumps and tumors appear, it can conceal cancer from detection.
Feigin explained that having dense breast tissue increases a woman’s risk of developing breast cancer, which is the second reason breast density is significant.
Although there are no explicit next steps for patients with dense breasts under the new notification requirements, it is advised that women speak with their providers to better understand their personal risk and choose a screening plan that suits them.
Even though mammograms are advised for all women beginning at age 40, some women with dense breasts may find that additional imaging modalities, like MRIs or ultrasounds, are helpful for breast exams.
JoAnn Pushkin, 64, is a breast cancer survivor who has pushed for a national mandate requiring women to be informed of their breast density for more than ten years. It’s been a while coming, she said, for the new regulation.
Despite having a normal mammogram eight weeks prior, Pushkin, who was in her mid-40s, wasn’t overly concerned when she found a lump in her breast.
Nevertheless, Pushkin was informed by the radiology technologist that there was nothing visible when she returned for a diagnostic mammography. “.
Pushkin believed the technologist had misidentified her as a different patient.
Pushkin remarked, “I just assumed that she’d come back into the wrong room. It was a large facility with multiple waiting rooms.”. “Oh no, I’m the woman with the enormous lump—I could feel it,” I exclaimed. She then said to me, “Oh, your breasts are dense.”. We will have a very difficult time finding that. And I recall saying to her, “Wait, what?” as I sat back, not even understanding what she was saying. “.
Despite Pushkin’s mammography at the time not showing the lump she felt, she underwent additional testing and had a breast ultrasound.
“And there it was, the lump as obvious as a bell,” stated Pushkin. Breast cancer was identified as the cause. I discovered I had dense breasts, breast cancer, and that it had gone unnoticed because of my breast density in less than twenty minutes. “.
Pushkin claimed she had eight operations and eight rounds of chemotherapy as part of her treatment after receiving a diagnosis at a later stage of the illness.
“I had a recurrence a few years later, followed by thirty radiation treatments. As a result of it being discovered at a later stage, I now have lymphedema,” stated Pushkin, who has testified before the FDA regarding breast density and co-founded the breast density resource website DenseBreast-info . org.
“I believe that by not being informed that I have dense breasts, I was essentially deprived of the chance to receive an early diagnosis. “.
required of every patient undergoing a mammogram.
As of right now, a tracker on the DenseBreast-info website indicates that approximately 39 states and the District of Columbia have mandated that patients receive letters regarding their mammogram results that include some information about their breast density. Advocates have pushed for a national requirement because the wording of state mandates varies and does not always require providers to inform a patient about their risk.
Notifying patients about their breast density will become mandatory nationwide upon the implementation of the new FDA rule.
Dr. Wendie Berg, a radiology professor at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, who co-founded and currently serves as chief scientific advisor of DenseBreast-info . org, stated, “This will provide a uniform national standard now so that all women in all states, when they have a mammogram, will be told either that their breasts are dense or that they’re not dense.”.
According to recent FDA regulations, healthcare facilities must inform patients about their breast density and explain to them how breast density may affect a mammogram’s accuracy in a letter accompanying the result.
Breast tissue can be either dense or not dense. Here’s an example of a notification statement. In addition to increasing the chance of getting breast cancer, dense tissue makes it more difficult to detect breast cancer on a mammography. You have thick breast tissue. Besides a mammography, additional imaging tests may be helpful in detecting cancers in some individuals with dense tissue. Discuss breast density, breast cancer risks, and your specific circumstances with your healthcare provider. “.
Or it might say something like this: “Dense or non-dense breast tissue is possible.”. Dense tissue increases the risk of breast cancer development and makes it more difficult to detect breast cancer on a mammography. You don’t have dense breast tissue. Speak with your doctor about breast density, breast cancer risks, and your unique circumstances. “.
Recognizing breast density.
A mammography report will include four categories of breast density, from mostly fatty to extremely dense, according to Berg.
These women are far less likely to develop breast cancer because their breasts are typically fatty, making it easier to spot cancers. The next group, which is actually the most prevalent, is scattered fibroglandular density, according to Berg.
“And then heterogeneously dense, which can obscure masses; in that category, at least 25% of cancers will go undetected,” the speaker stated. Finally, the category with the highest density would be the one in which at least 40% of cancers would go undetected. Furthermore, there is actually a four-fold increased risk of breast cancer in women with extremely dense breasts compared to those with fatty breasts. “.
Ten years ago, Berg said she did her own research and found that she had a 19.7 percent lifetime risk of getting breast cancer based on her breast density and her own family history of the disease. This is why she refused to have a 3D mammogram and insisted instead that she have an MRI of her breasts to check for cancer.
Berg, who has since received treatment for the illness, stated, “The MRI revealed a small invasive cancer that you can’t see on my own mammography.”.
“Following that ordeal, I opined that women should have a designated area to determine whether they fit the requirements for an MRI or ultrasound, and to understand the implications of these examinations,” Berg stated.
According to the FDA, mammograms alone may not always be the only imaging test needed to detect cancer in certain individuals with dense breast tissue.
But that is all that is said in it. Finally, it says, “Speak with your healthcare provider,” according to Berg. “There is room for improvement in the clarity of the guidelines. “.
Many women may be unsure of when to request further imaging, like an MRI, or in certain situations, their doctor may disagree that they require it. These choices might not be covered by insurance in specific situations as well.
According to Molly Guthrie, vice president of policy and advocacy at Susan G. Komen, “knowledge is power, and all women can now have informed conversations with their medical providers about the screening plan that’s right for them based on factors influencing their personal breast cancer risk, including breast density.”. Komen stated in a press release.
Guthrie said, “We want everyone to know that dense breast tissue alone does not require additional imaging—it is just one factor in breast cancer risk.”. “Out-of-pocket expenses can be a deterrent for people who do require imaging tests beyond mammograms. We have been pushing for state and federal legislation to do away with these costs because of this. The availability of technology allows us to identify breast cancer early and save lives; financial constraints shouldn’t be an obstacle. People must be aware of their personal risks and be able to affordably obtain the breast imaging that they require. “.
Availability of high-quality mammograms.
Proud of the FDA’s new rule, which it claims will shorten diagnosis delays, is the American Cancer Society. In her lifetime, 1 in 8 women are expected to get breast cancer.
The American College of Surgeons (ACS) said in a statement last year that “the final rule will improve screening by addressing newer technologies, better enforcement of facility accreditation and quality standards, and enhancement of the reports that are provided to women and their physicians.”.
All women should have access to high-quality mammograms, the American College of Surgeons stated at the time, even though the new regulations may lower the death rate from breast cancer.
The organization states that there is a persistent disparity in breast cancer mortality rates between Black and White women, with Black women being more likely to undergo lower-quality screening.
According to a study released in 2022, between 1989 and 2020, there were 460,000 fewer deaths from breast cancer, or a 43 percent decrease in the death rate from the disease. Black women had a 40 percent higher death rate overall from breast cancer than White women, despite having a lower incidence rate overall, according to racial data analysis.
Screening is either crucial or it isn’t. According to Pushkin, women who are known to be at a higher risk and for whom a mammogram is a compromised tool should prioritize this if it is indeed important. Women have the chance to stand up for themselves when they are informed about their beast density. If you don’t have enough knowledge to know that you need to, how can you advocate for yourself?
