October is Breast Cancer Awareness Month: Current issues include the new breast density law and controversial breast screening guidelines
By Lisa Loring, MD
If you’ve had a recent mammogram, you may have received something new in your report. Last year, a state law passed requiring mammography providers to inform patients if they have dense breast tissue. This new information can be confusing - and even frightening. As we observe Breast Cancer Awareness month, now is a great time to explain this new law and what it means for women.
The first thing to understand is that half of all women have dense breasts, so it’s common. This has nothing to do with the shape or size of the breasts, or how they feel. Breasts are composed primarily of fat and milk ducts or glandular tissue. If greater than 50% of the breast tissue is glandular on the mammogram, the breasts are considered dense. This is completely normal. In most cases, nothing has changed about your breast health.
There are two reasons that breast density matters. First, dense breast tissue appears white on the mammogram. Tumors also appear white on the mammogram. There can be a masking effect akin to a polar bear in a snow storm. By comparison, fatty breast tissue appears black on a mammogram and provides better inherent contrast to detect white tumors. Secondly, some studies have shown that there is a small increased risk of developing breast cancer among women with dense breasts as opposed to average density breasts.
So what do you do if you have dense breasts? You probably don’t need to do anything right away. Speak to your health provider about other risk factors for breast cancer, including a family history or a genetic link. Your physician may advise another form of breast cancer screening, such as 3-D mammography (tomosynthesis), breast ultrasound or MRI to assure the health of your breasts.
The new breast density law is another piece of information that helps us better manage our breast health. Above all, mammograms save lives every day. Since the inception of regular mammographic screening, mortality from breast cancer has decreased 35%. This is why the revised screening mammography guidelines from the United States Preventive Services Task Force are very concerning. They now suggest that women begin screening mammograms at age 50 and every other year thereafter if there is no significant risk of breast cancer. For women in their 40’s, the Task Force suggests they should decide for themselves.
I strongly disagree, as do most of my colleagues nationwide who specialize in breast health, as well as the national organizations that guide cancer screening policies. No one on the Task Force has expertise in breast imaging, their analysis was never made public, and the group used relatively old and flawed studies as the basis of its research.
In my opinion, the most compelling issue around this debate is the fact that 17 percent of women diagnosed with breast cancer nationally are in their 40’s – an age group that is overlooked in the new screening recommendations. This is a worrisome scenario.
Breast cancer experts continue to recommend annual screening mammography beginning at age 40, which offers far more protection for women with very little radiation. If your mother had breast cancer, we recommend a first screening 10 years prior to the age at which your mother was diagnosed. Women who have other known family and genetic risk factors may need a different screening schedule that is decided on an individual basis.
Even the best efforts to maintain good health cannot guarantee that you will not get breast cancer. In fact, 75 percent of all women diagnosed have no known risk factors. What we do know is that annual mammograms have saved millions of lives. Make sure that your life is among them. It’s October. Schedule your mammogram.
Lisa Loring, MD, Chairman of the Department of Radiology at Berkshire Medical Center, also serves as Medical Director of the Women’s Imaging Center.