Deep in the legislation that congress passed to fund the government for the next year is an important set of new recommendations for women with dense breasts.
Millions of women have dense breasts and many don’t even know the term. When it comes to screening for breast cancer, it’s an important classification because dense breasts make it difficult for traditional mammography techniques to detect cancer. The latest type of breast cancer detection, called 3D mammography, is highly recommended for women with dense breasts. What’s going to change now, is that the congress, by dint of legislation, has instructed the Food and Drug Administration to require that women who receive mammograms also receive information about dense breasts and the additional challenges they may have for breast cancer detection.Read More
“Fatty breast tissue has sort of a grey appearance. An X-Ray beam just runs right through it. But the dense structures, they block the X-Ray and so that looks white,” says Dr. Connie Lehman, Chief of the Breast Imaging Division at Massachusetts General Hospital. “Unfortunately cancers also block the X-Ray, and so cancers also look white. And so when you have a white cancer, hiding in white dense breast tissue, it can be missed.”
“Digital mammography, it turns out, significantly improves the quality of the mammogram,” says Dr. Lehman. “We also have a new tool that’s even more exciting, it’s 3D tomosynthesis mammography. This allows us to find more cancers and to significantly reduce our false positive rate,” so the new technologies available make 3D pictures of the breast that are useful for catching breast cancer.
“We’re taking thin slices through that breast tissue, like slices through a loaf of bread, and we can look at each slice independently, rather than trying to see through the entire thickness of the entire loaf of bread,” says Dr. Lehman. “So those thin slices help us find things that were hidden in all the multiple layers, and also important is that some of the things that looked a lot like it could be a cancer, when we went through the thins slices saw that this is just overlapping, normal breast tissue, and that’s when we reduce our recall rates significantly.”
“I highly recommend that women go to high quality centers and ask for a tomosynthesis 3D mammogram. It’s a better mammogram. Lower false positives, better chance of finding those cancers through those thin slices, and at high quality centers in the right hands, it can really improve the mammography experience,” says Dr. Lehman.
“Dense breast is considered a significant risk factor because of two reasons,” according to Dr. Cindy Ly, Doctor of Radiology at NYU Langone Medical Center. “First, it has a masking effect on how well we can perceive cancer and find cancer on mammograms. Second reason is that it means the patient’s have more fibroglandular breast tissue, which produced a density on the mammogram. When you have more breast tissue, your risk for breast cancer is significantly higher.”
“So in general, breast density increases when you are a younger woman. So, that means you have more fatty breasts and less dense breasts as you get older in general,” says Dr. Ly. “But it’s really an individual difference. Most of our younger patients will have dense breasts by nature. And the only way to tell if your breasts are dense is to have a mammographic evaluation. Clinical breast exam is great but it’s not very reliable on determining whether your breasts are dense, and other form of breast imaging, such as ultrasound and MRI are not as cost effective in determining whether you have dense breasts.”