This seems to be an increasingly common experience: A woman goes in for an annual breast cancer screening and the radiologist spots something suspicious on the mammogram. The woman is notified that she needs to return for additional tests. After much anxiety, she is told she is in the clear.
These false-positive mammograms happen repeatedly to many women, but especially to those with dense breast tissue. Unfortunately, for those women, there is another circumstance that’s even more terrifying.
A woman goes in for her annual mammogram. It comes back normal, but she learns she has dense breasts. She requests further testing only to learn her previous results were wrong and she does, in fact, have breast cancer.
Several women share some variation of this story as testimonials for Margie’s Army Foundation, a Pooler-based nonprofit that helps women in their fight against breast cancer and raises awareness about breast density.
Breast density, a measure of how much fibrous and glandular tissue is in the breast compared with the amount of fatty tissue, is not correlated to breast size or firmness. On a mammogram, cancers show up as white spots and blend in with dense tissue, which also shows as white.
Complications that come with dense breast tissue can range from annoying to terrifying, and women need to have a better understanding of the risks.
In 2019, thanks to the efforts of the Margie Singleton, founder of Margie’s Army Foundation, Georgia became the 38th state in the nation to mandate that health providers inform women that they have dense breast tissue.
Almost 50% of women have dense breasts and could benefit from other forms of screening. Understanding breast density is an important part of helping to empower women with information.
Next month, a federally mandated system will require mammography reports to include notice of breast density to women in all states. The reports will also give women with dense breasts context on what that means as well as guidelines on talking to health care providers.
It doesn’t help that the medical community has yet to standardize screening guidelines for women with dense breast tissue. Radiologists, in conjunction with other care providers, can order more sensitive tests — such as an ultrasound or an MRI — but insurance plans may not pay for additional screening.
I have dense breast tissue and each year I dread getting a mammogram in part because it is a confusing process that can drag on for weeks.
I go in for a routine screening, which often leads to an additional screening and, several times, has led to biopsies. At one point, I was referred to a breast specialist. One year, the logistics of my care were so jumbled that I had two different orders for two different types of mammograms from two different doctors.
I also routinely paid in excess of $1,000 for additional screenings that were not covered by my insurance. And I spent significant amounts of time stressing over the outcome of the tests. It was all so overwhelming.
It does feel as if the process has improved in recent years. Last year, I had a 3D mammogram (digital breast tomosynthesis) that was partially covered by my insurance. But I’m still not sure I know exactly what type of screening I should get: Is a 3D mammogram enough? Do I need an ultrasound? An MRI? Will I have to pay all or a portion of it out of pocket?
In April, the U.S. Preventative Services Task Force (USPSTF), which most physicians rely on for guidance, released updated recommendations for breast cancer screenings but stopped short of setting specific guidelines for women with dense breasts.
Dr. Wendie Berg, a professor of radiology at University of Pittsburgh School of Medicine, in an editorial for JAMA Oncology, noted the benefits of supplemental screening for these women, particularly 3D mammography and MRI.
But Berg also said in an interview with Health Imaging that more research may be needed. While there is solid clinical evidence supporting some additional and emerging screening technologies (ultrasound, contrast-enhanced mammography, MRI) in women with dense breasts, Berg said randomized trials may be necessary before any task force recommendations are made.
In July 2022, author Elizabeth L. Silver was diagnosed with stage 3 breast cancer, nine and half months after having a normal mammogram. At 43 years old, she is among a growing number of younger women who are being diagnosed with late stage breast cancer.
Silver, recounting her experience in an article for Ms. magazine, points to breast density as the problem and suggests that automated supplemental screening for women with dense breasts would be a helpful solution.
Or we could just change the standard for everyone.
“If we did MRI as the routine screen for everyone, we probably would save (almost) everyone from breast cancer,” Dr. Daniel Kopans, a recognized authority on breast imaging, said in the article.
It took 40 years for mammography to become an accepted technology and almost 20 more years for it to be officially recommended by the medical community.
It shouldn’t take another half-century to make supplemental testing more accessible to all women, and particularly, to the women who need it most.
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