Monday Medical: Mammogram reports to detail breast density
October 1, 2017
STEAMBOAT SPRINGS — On Oct. 1, a new law went into effect for Colorado that requires doctors performing mammograms to alert women if their breasts are dense.
States have been adopting versions of the law since 2009, when a Connecticut woman learned she had advanced breast cancer soon after getting her eleventh normal mammogram. Her cancer had gone undetected in part because she had dense breasts, which have relatively more fibrous and glandular tissue, and less fatty tissue.
"We've known for years that mammography is not a perfect test," said Dr. Terese I. Kaske, breast radiologist and medical director of the Gloria Gossard Breast Care Center at UCHealth Yampa Valley Medical Center. "Mammography is a good test. It has been proven to find early breast cancer and reduce mortality from breast cancer by 30 to 40 percent. But it can miss things. And it can miss things more often in women with dense breast tissue."
Doctors with the Gloria Gossard Breast Care Center were already letting women know if their breasts were dense but now sharing that information is a requirement.
"We're educating women about their breast density and the limitations of mammograms," Kaske said. "Informing women that they have dense breast tissue, that it is not an abnormal finding, it's just the way some women are."
In fact, of the women who received a mammogram at the Gloria Gossard Breast Care Center between July 2016 and July 2017, 51 percent had dense breasts. That rate is higher than the 40 percent of women across the U.S. identified as having dense breasts during the same time period.
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Dense breasts can make it difficult to see potentially cancerous masses with a mammogram, even with the newest digital tomosynthesis, or 3-D digital mammography, which is the standard of care at the Gloria Gossard Breast Care Center.
"Looking at a fatty breast has been compared to a clear sunny day. You can see through it easily with a mammogram. If there's a tiny mass, we see it," Kaske said. "But in a very dense breast, it's like a really cloudy day. It can be harder to see defined margins and identify masses."
Additionally, experts think that having dense breasts slightly increases a woman's risk of getting breast cancer.
For women with dense breasts, additional screening can be considered. Those at average risk of developing breast cancer may receive a screening breast ultrasound.
"A screening breast ultrasound is not as expensive as an MRI and can find small cancers that a mammogram might miss," Kaske said. "But whenever we look more closely, sometimes we find things that don't turn out to be cancer. So there is a risk-benefit to consider."
Another option is a breast MRI, which is already recommended for high-risk women.
The additional tests provide another baseline with which to compare with down the road, and both tests are available at YVMC. And while the additional tests are helpful, Kaske stressed that they don't replace mammography.
"Mammography is incredibly well studied over many years and has been shown to be a good test to find early breast cancer," Kaske said. "But now, also offering breast ultrasound or MRI will improve screening strategies."
Kaske also reminds women that it's important to get a mammogram every year starting at age 40.
"Other organizations may have shifted their recommendations, but the Society of Breast Imaging and the American College of Radiology still believe in having screening mammography yearly," Kaske said. "Hopefully, we never find anything, but if we do, we want to find it small and curable. Early detection saves lives."
For more information, contact the breast health nurse navigator at 970-875-2623.