One in eight American women will be diagnosed with breast cancer in her lifetime. In June of 2012, children’s author Judy Blume was among them. Because the 74-year-old Blume has dense breasts, a mammogram and physical examination didn’t reveal her cancer. She’s now recovering from a mastectomy and reconstruction.
Even with annual mammograms and manual exams, dense breast tissue can conceal a cancer for years. In some cases, mammograms do not detect cancer even in patients with a palpable lump. The primary reason is the way dense breasts affect image quality. On a mammogram, dense breast tissue looks white, making it harder to spot cancer, which also appears white.
Breast density depends on many factors, including age. One study showed that almost 75 percent of women in their forties had dense breasts.¹ Generally, this decreases as women age. Unfortunately, women won’t know if they have dense breasts unless they ask the radiologist who performed the mammogram or the physician who reviewed their mammogram report. Several states, including Connecticut, Texas, Virginia and New York have passed legislation requiring mammogram providers to tell women if they have dense breasts. Similar laws have been introduced in other states and in Congress.
While dense breasts make it harder to detect cancer, a National Cancer Institute study concluded that patients with dense breasts were no more likely to die from cancer than similar patients with less breast density. The study tracked more than 9,000 breast cancer patients.
Knowing the challenges associated with dense breasts, physicians can be alert to potential problems. While mammograms and manual exams are still advised, patients with a family history of breast or ovarian cancer or genetic mutations associated with breast cancer can also be screened with a breast ultrasound or an MRI. The protocol at the Breast Care Center of Osceola Regional Medical Center is ultrasound and MRI if the patient has a family history, breast pain or a palpable lump not found on a mammogram. In some cases, a needle biopsy is necessary to make a definitive diagnosis.
As helpful as additional tests might be, there is no conclusive evidence that they save lives and they may create false alarms. There’s also no standard measurement for breast density – it can vary from one physician to the next and from one year to the next. One promising factor, however, is a University of California at San Francisco study. UCSF is currently performing a large study to determine the most accurate screening method for patients with dense breasts. Until then, physicians must consider the big picture – family history, reproductive history, previous biopsies, breast density – to determine overall risk. And don’t forget to remind patients that one of the best protections is also one of the simplest: monthly self-exams.
¹American Society of Breast Surgeons, 2009.
Article by Tejal Patel, MD
Tejal Patel, MD is a Board Certified Diagnostic Radiologist and Women Imaging Specialist at the Breast Care Center of Osceola Regional Medical Center, 730 West Oak Street in Kissimmee. Dr. Patel is a graduate of Ross University School of Medicine and served her residency at University of Illinois Medical Center and fellowship at Mercy Hospital Medical Center.