Breast density makes detection of cancer harder in 2D mammography
By Emma Palova
Grand Rapids, MI- Being a woman, a mother, a grandmother, a sister and a daughter is a joy. However, the number one risk factor for developing breast cancer is just that; the simple fact of being a woman. Being a woman with a dense breast tissue increases the risk further.
Although dense breast tissue is not an independent risk factor, it can make it harder to find cancer through a traditional two-dimensional (2D) mammography, according to Kent County Medical Society (KCMS) & Kent County Osteopathic Association (KCOA) bulletin.
As of June 1, 2015 breast imaging centers in Michigan are required by law to notify women if they have dense breast tissue.
“Your mammogram shows that your breast tissue is dense,” will read on the report from the imaging center.
Approximately 50 percent of women undergoing screening mammography have dense breast tissue. Breasts are considered dense if they contain a majority of fibro glandular tissue. Fibro glandular tissue and breast masses appear similar on 2D mammograms, making it difficult to detect a small breast cancer.
Karen Jarrell attested to that in her comment on the WOTV4women “Are you dense?” recent series.
“I had a mammogram in March 2014 that was clean. In December I was diagnosed with stage 2 breast cancer. Only when diagnosed did I learn I had dense breasts despite having a mammogram routinely.”
If a woman with dense breast tissue is at high risk, as determined by the Gail Risk Score, further screening may be appropriate. A good starting point is a breast cancer risk assessment, according to the KCMS/KCOA bulletin.
“Women need to know the risks in addition to having dense breast tissue,” said Dr. Jamie Caughran, medical director at the Mercy Health Comprehensive Breast Center in Grand Rapids.
Top risks include age, gene mutations, breast cancer is higher among women who have first degree relative with breast cancer (mother, sister or daughter), and personal history of breast cancer three to four fold increases the risk of a new cancer.
The additional screening options include 3D mammography or Digital Breast Tomosynthesis, now available in Kent County. The cutting edge technology produces a conventional 2D mammogram while also acquiring images of individual layers of breast tissue which can be viewed as an aggregate. This diminishes the masking effect of dense breast tissue, compared to the 2D image.
The 3D technology allows the radiologist to more accurately distinguish normal fibro glandular tissue from an underlying mass.
“3D mammography helps in the setting of dense breasts,” said Caughran. “It reduces the chances of screening patients having to come back for additional views and improves our cancer detection for masses in dense breasts.”
Insurance coverage varies. Priority Health and Medicare are covering diagnostic as well as screening. 3D is often performed as part of a diagnostic evaluation for a mass or known imaging finding.
Tomosynthesis (3D) is appropriate for patients with prior mammograms read as heterogeneously dense or extremely dense breasts, patients who are at high risk for developing breast cancer, and for patients who have strong desire to pursue 3D screening but do not fulfill either of these criteria.
The out-of-pocket cost is $150.
In high risk patients, MRI can be performed in addition to the 3D, as well as ultrasound as a side test.
Caughran said she is not in favor of additional 3D on top of a 2D because of double radiation.
“Do one exposure instead,” she said. “Come up with a plan. Know your density and risk level. The lack of coverage shouldn’t be an issue. We have grants and programs to cover.”
Caughran recommends for all women once a year mammogram, monthly self-exams and yearly exams at your doctor.
For more information go to http://www.breastdensity.info
Sources: Kent County Medical Society & Kent County Osteopathic Association (KCMS/KCOA}
Cutlines: Dr. Jamie Caughran, breast surgeon and medical director at the Mercy Health Comprehensive Breast Center, Grand Rapids
Graf of levels of density:
- The breasts are almost entirely fatty.
- There are scattered areas of fibro glandular density.
- The breasts are heterogeneously dense, which may obscure small masses.
- The breasts are extremely dense, which lowers the sensitivity of mammography.
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