More than Mammograms Needed to Diagnose Breast Cancer

Twelve states have enacted laws requiring physicians to inform women when their mammograms show they have dense breast tissue.  New Jersey is not one of them.  I helped introduce a breast density inform bill in the New Jersey Senate two years ago; it is now being picked apart and diluted in the New Jersey Assembly.

Legally, radiologists are required to tell referring physicians about their patients’ density.  But no one is required tell the patients.  Until every state has a law, or a federal law is enacted, those of us on the front lines are trying to get the word out to women that breast density is a cancer risk.   

The American College of Radiology (ACR) estimates that 47 percent of women have dense breast tissue and women with density are two to six times more likely to develop breast cancer.  Not only does density increase the risk of cancer; it can interfere with the accuracy of mammograms.

 Briefly, breasts are composed of three kinds of tissue:  fatty, glandular and fibrous. Fatty tissue is black on a mammogram. Glandular and fibrous – the dense tissue - are white.  Tumors are also white so they can be hidden by the dense tissue.  It’s like looking for a snowflake in a snowstorm - a perfect storm for missed cancers on a mammogram.

Women with dense breast tissue still need mammograms because there are abnormalities that are only seen with mammograms such as microcalcifications and subtle tissue distortion.   Breast density inform laws suggest that women with dense breasts talk to their doctors about supplemental screening – tumors are seen differently on other imaging modalities such as Ultrasound, Tomosynthesis, Magnetic Resonance Imaging (MRI) and Molecular Breast Imaging (MBI).  Women with a strong family history of breast cancer should also consider Genetic Testing.

Individualized risk assessment is necessary to determine what type of screening a woman should have and how often she should be screened. I frequently tell patients that breast cancer diagnosis is a puzzle and a radiologist has to be a detective who tracks down the pieces and puts them together.  Technology provides the tools; we have to use them in the right way.

Be your own advocate.  Know your family history and have an annual mammogram at the minimum. Ask your doctor whether or not you have dense breasts and if you do, discuss supplemental screening.  You need to complete the puzzle that is your breast health.