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On July 1, Indiana became the latest among a handful of states to require clinics that screen for breast cancer to send women a letter after a mammogram informing them if their breasts are dense.
That red flag signals a patient is statistically more likely to develop breast cancer than women with fatty tissue.
Dense breast tissue — which shows up on a mammogram as white streaks or splotches — makes it harder to detect existing signs of breast cancer, which also show up on a mammogram as white objects due to the hardness of a tumor. Some doctors describe the search for a tumor in a patient with dense breasts as looking for a polar bear in a snowstorm.
A health study published in the Harvard Health Policy Review also found that women with dense breasts have a three-to-five-times higher risk of developing breast cancer than women with fatty tissue. Fatty tissue shows up on a mammogram as dark gray material, and that is generally in sharp contrast to the white hardness of a tumor, making the cancer easier to detect.
Deana Tuell, manager of the Breast Health Center at Columbus Regional Hospital, said that clinic does as many as 7,000 breast cancer screenings per year, and it has started sending out revised letters to describe mammogram results to patients.
The old letters simply told patients if their results were normal, not normal or if they needed to return for another test.
Now, the letters add a lengthy paragraph recommended by the American College of Radiology to provide education for women with dense breasts. It reads as follows:
“The mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. But dense breast tissue can make it harder to find cancer on a mammogram. Also, dense breast tissue may increase your breast cancer risk. This information about the result of your mammogram is given to you to raise your awareness. Use this letter when you talk to your doctor about your own risks for breast cancer, which includes your family history. At that time, ask your doctor if more screening tests might be useful, based on your risk.”
Tuell said she believes the new letters will lead to more questions for physicians from patients concerned or curious about what their level of breast density might mean.
Radiologists have known for many years that dense breast tissue carries increased risk of cancer, and that the whiteness associated with it can mask the presence of tumors.
About 40 percent of women who have mammograms have dense breast tissue, medical studies show, so it is a frequent and naturally occurring body characteristic.
Connecticut led the way
A national push to require more education about dense breast tissue didn’t kick into high gear until a Connecticut woman named Nancy Capello was diagnosed with advanced breast cancer just two months after getting a clean bill of health from a mammogram in 2004.
It turned out that Capello had dense breast tissue and that its presence made detecting cancer a lot more difficult for health-care providers during the screening exam.
Five years later, Connecticut became the first state to pass a law requiring women to get a notice from health care providers if the patient has dense breasts. Texas, Virginia, California and New York were among states that soon followed.
Tuell said the Breast Health Center in Columbus didn’t take a position on the Indiana legislation. But the clinic stood ready to follow the new rules starting July 1 once the bill became law.
Still, some physicians object to the notification rules around the country, suggesting it could lead to unnecessary tests and even biopsies. Critics point out that two doctors reading the same mammogram may rate the tissue they see differently.
Conversely, many health advocates argue that women have a right to know all the risk factors associated with dense breasts, and the new legislation could save lives.
Tuell said increased testing that may result could raise overall costs for some patients. In other instances, Tuell said dense tissue can be manipulated during a mammogram to give health care specialists a better view — and clearer results — by spreading out the tissue or by using smaller compression paddles to get better pictures in an exam.
At a glance
What is breast density?
Breasts are made up of a mixture of fibrous and glandular tissue and fatty tissue. Breasts are considered dense if there’s more fibrous and glandular tissue and not much fat. Density may decrease with age, but there is very little, if any, change in most women.
Why is density a key factor in cancer screenings?
Having dense breast may increase the risk of getting breast cancer. Also, mammogram results can be less accurate in women with dense breasts.
What steps should a patient with dense breasts take?
If you have dense breasts, talk to your doctor about the ramifications and if any additional screening exams are right for you.
Source: The Breast Health Center, Columbus Regional Hospital
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