It is no longer surprising that everyone seems to have expert knowledge on breast cancer, despite having no training, expertise or experience in identifying and taking care of women with such a disease. While the June 20 editorial (“A new and dubious breast cancer law”) pointed out some of the drawbacks of the Breast Density Bill, it is incomplete and misses the purpose of the bill.
While the Star Tribune noted that the American Cancer Society and the Minnesota Medical Association were neutral on the legislation, the Minnesota Radiological Society, the group of physicians who actually diagnose women and would implement the specifics of the bill, was supportive. The editorial hearkens back to days past when women were told they were “OK,” the doctor will take care of it.
What are the specifics of this “thoughtless” bill?
1) Women with dense breasts have an increased risk of breast cancer.
2) Women with dense breasts on mammography should be notified that detecting cancer on their mammogram may be more difficult.
3) Such women may wish to consider additional methods of screening for breast cancer.
Women are already notified in writing of the results of their mammogram. This additional information will not be a burden to add. What the editorial did correctly state is that there needs to be education on what the information means.
What does having a dense breast mean? First, 50 percent of women have dense breasts. The vast majority of these women have heterogeneously dense breasts, which means they are only mildly increased in density. Approximately 10 percent have extremely dense breasts. For a woman with mildly increased density, the risk of breast cancer is 1.2 times normal, a very small increase in risk. For a woman with an extremely dense breast, the risk is two times normal, still a modest increase in overall risk.
When we look at a mammogram, a breast cancer is almost always a white spot or white dots. The mammogram of a woman with a dense breast has a white background, so finding the white spot or dot is harder than in a breast with a gray (or fatty) background. It is not impossible, though, and breast cancers are found in women with dense breasts every single day.
Some 80 percent of cancers will be found in these women with breast cancer if digital mammography is performed. However, if film-screen mammography is performed, it drops to 50 percent. Because of the decreased sensitivity in identifying possible breast cancer, it means that these women and their physicians need to be aware of physical findings in the breast that may not be identified on the screening exam. It also means that they may want to look at other means of diagnosing breast cancer, depending on their history and genetic makeup.
What can be done? First, continue breast self-exams. One reason for the breast density awareness bill is so women with dense breasts do not become complacent. Some women believe that if their mammogram is normal, there isn’t a breast cancer. Women with dense breasts need to be aware that their mammogram is not as sensitive and that breast self-exam is that much more important.
Second, make sure you have a digital mammogram if you have dense breasts.
Third, ask if your facility is using any additional mammography methods to detect breast cancer, such as breast tomosynthesis, also called 3-D mammography. This modification of the mammogram allows for a clearer image and it detects more cancers in the dense breast, while not increasing the number of women recalled.
One may also wish to consider Screening Whole Breast Ultrasound or Screening Breast MRI. Both of these tests have been shown to find more breast cancers, but they are not as specific and will result in extra examinations, many extra biopsies and will not normally be covered by insurance. That is why a discussion should take place to see if these additional tests will be useful.
A helpful website for patients and physicians is one by the California Breast Density Information Group at http://www.breastdensity.info.
By being informed, women can make a rational decision as to what is right for them, regardless of the agenda of any advocacy group.
Joseph Tashjian is a radiologist in St. Paul.