Every year, thousands of young women go for a baseline mammogram, nervous and anxious due to this new experience, yet sure that they have nothing to worry about. They leave the medical facility and wait a few days to get a “happy gram” in the mail: a note that proclaims all is well, that there was “nothing suspicious” and to remember to call for next year’s appointment.
But next year’s appointment may be too late. Sixty percent of young women’s breasts are dense, and due to this, mammograms miss half of dense breast tissue cancers. And it’s not only young women (premenopausal) who need to be concerned: “Dense tissue” describes breast tissue in 43 percent of the female population, including 40 percent of postmenopausal women.
Breast tissue is categorized four ways: almost entirely fat, mostly fat with some dense tissue, moderately dense, and predominantly dense. Women with dense breast tissue are six times more likely to develop breast cancer. And, if they have it in one breast, they are twice as likely to have it in the other.
According to a JAMA Oncology report of 202,748 women, “breast density and body mass index had the largest individual population attributable risk proportion. Thirty-nine percent of premenopausal women and 26 percent of postmenopausal breast cancers could be prevented if breast density in women with dense breasts was reduced by scattered fibroglandular densities on the Breast Imaging Reporting and Data System scale.”
To be clear, mammography has its place, and is needed to determine the density of the breasts, but it shouldn’t be used as a standalone for women who do have dense tissue. Ultrasounds and MRIs, in conjunction with mammograms, should be considered as standard screenings for women with dense breasts, especially those with a previous cancer diagnosis, or who are in another high risk group. Yet, they are not. Women unaware of this cannot begin to advocate for themselves. Medical professionals, who are not mandated to inform patients of their density and possible ramifications, often don’t.
According to a 2012 RSNA Radiology review, a “Breast Density and Mammography Reporting Act was introduced in the 112th Congress and would require that every mammography report contain information regarding the patient's breast density and language communicating that individuals with more dense breasts may benefit from supplemental screening tests.” The authors conclude by stating, “a mandate to disclose the association increased risk for cancer directly to individual patients seems ethical, reasonable, and appropriate."
Ethical, reasonable and appropriate — these words spoken six years ago echo the importance of notifying women. But currently no national standard to report or disclose breast density exists. Thirty states have worked on bringing laws forward, and a few have succeeded. Utah is not one of them, which is why it is imperative that dialogue in the Beehive State changes. HB258, sponsored by Rep. LaVar Christensen, seeks to do just that: notify women of their tissue type, encouraging further discussions with their medical professional, to include the need for further testing, if deemed necessary based upon risk factors.3 comments on this story
To wit, breast density is recognized as an established independent risk factor for developing breast cancer. In fact, it is a stronger risk than having a first degree relative with the disease (doubled risk), or two first degree relatives (five times risk). Simply put, dense breasts are more likely to develop cancer than if a sister and aunt have both had breast cancer.
Women have a right to know their breast density. They also have a right to know that 3-D mammograms, MRIs and ultrasound screenings can also be employed to better detect cancers. The connection between dense breast tissue and failed regular mammograms is too high to ignore. It is imperative that Utah women be granted the knowledge to become more powerful in protecting their own health.