On July 1, 2019, a new law took effect in Georgia that mandates that patients with dense breast tissue identified on their mammograms be notified of this finding in the letter they receive explaining their mammogram results.
A: Breast density is a measure of how much fibroglandular (dense) tissue is present in a woman’s breast compared to how much fatty tissue is present. Breast density can vary with factors such as age, changes in weight, and hormone usage, but for many women it does not change throughout adulthood.
A: The doctor who reads your mammogram will indicate in their report which of the 4 density categories best matches the appearance of your breasts. This information will be sent to your doctor and you will also be notified in your results letter.
A: Regardless of your breast density, it can be helpful to speak with your healthcare provider about your individual risk for breast cancer. MRI has been recommended for many years as a supplement to mammography for all women with a 20% or greater lifetime risk of breast cancer. This includes women with genetic mutations such as BRCA and their close relatives, women with a history of radiation therapy to the chest between the ages of 10 and 30 (such as those who had Hodgkin’s Disease), and other high risk patients. The American College of Radiology recently updated its guidelines to also recommend yearly MRI for women with a personal history of breast cancer plus dense breasts and women with any breast density who had breast cancer before age 50. MRI is often covered by insurance for women with these types of risk factors.
If your breasts are dense, but you do not have other risk factors, you and your provider should discuss additional screening options, which can find some additional cancers, but can also lead to further testing and biopsies for findings that are not cancerous.
If you choose to have additional screening, MRI is the test that has been shown to find the most additional cancers while minimizing the number of additional tests needed for findings that are not cancer. The most important large national study that compared mammography, MRI, and ultrasound showed that the most cancers were found with the combination of mammography and MRI. Adding ultrasound to this combination did not find any additional cancers and resulted in recommendations for many more biopsies – more than 92% of which did not show cancer. For these reasons screening breast ultrasound should only be considered for patients who medically cannot have MRI.
Recently, a new type of MRI called “Fast MRI” has been developed to provide a quicker, less-costly alternative for women with dense breasts who do not have additional risk factors.