Like many women, Shama Mullen breathes a sigh of relief every time she receives good news about the results of her latest mammogram. But two years ago, Maren’s doctor sent her additional information that surprised her.
She had dense breasts.
“I had never seen a letter like that before, and I didn’t even know what dense breasts meant,” said Mullen, 38, of Andover, Massachusetts. Mullen immediately searched the internet for more information and called her doctor with questions about follow-up tests.
Women age 40 and older in all states now receive a breast density notification along with their standard mammography report. New rules from the Food and Drug Administration. Massachusetts and 38 other states already Sending notifications Regarding breast density, reflect the percentage From mammary glands and connective tissue to adipose tissue. FDA requirements standardize these messages.
dense organization becomes harder to find Breast cancer on mammogram. and the dense breast tissue is a risk factor for cancer.
You have a thick chest. Well, what is it?
mammogram research indicates approximately half A higher percentage of women over the age of 40 have dense breasts.
Women with dense breasts will now be encouraged to talk to their doctors and be told that “in addition to mammography, other imaging tests may help detect cancer.”
Some health advocates argue that the notice: You’re oversimplifying a complex problem. Without clear, evidence-based instructions, they Women can be left frightened, confused and frustrated.
Judith Gerber, a senior policy analyst at the Rohn Institute, a nonpartisan health policy think tank, said there are no national health standards. Follow-up for dense breasts I will report it.
This means that women will receive different advice from different doctors.
Some doctors recommend that women get additional tests such as additional mammograms, ultrasounds, and MRIs, while others advise them to continue getting regular mammograms, said Dr. Mark Perlman, professor emeritus at the University of Michigan School of Medicine. That’s what it means. Written screening guidelines for the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network.
“You can’t counsel all women with dense breasts with one policy that fits all,” Perlman says.
Whether a woman can undergo additional imaging tests It may depend on your insurance, but That doesn’t necessarily cover them, said Robert Smith, an epidemiologist and senior vice president for cancer screening at the American Cancer Society.
Smith said it’s important for women to know whether their breast tissue is dense.
radiologist Sorting breast tissue Divide into 4 groups.
- very dense
- almost dense
- high in fat
- It’s almost entirely fat.
Because breast cancer can hide behind dense tissue, “these cancers grow, get bigger, become more advanced, and eventually poke out from the corners of the dense tissue and become visible on mammograms.” ” said Smith. “Even if a diagnosis is made, it is not an early one.”
Smith added: “If the breast is completely dense, traditional techniques simply aren’t very accurate, so auxiliary image processing is needed.”
Dr. Hilary Marston, the FDA’s chief medical officer, said the notice will empower women.
“We really wanted to make sure that women were given the information they needed in plain language to make good decisions for their health,” Marston said. “The most important thing is to make sure people have access to information in a clearly communicated, high-quality way.”
Benefits and risks of additional testing
Part of the confusion is that experts disagree on whether women with dense breasts need additional imaging.
However, American College of Radiology and National Comprehensive Cancer Network We recommend that women and their doctors consider additional screening, two other influential groups. American College of Obstetricians and Gynecologists and U.S. Preventive Services Task Force — Says there is no evidence of benefit to recommend additional testing.
Additional tests can detect more cancers than mammograms alone, but no evidence that additional test save a lifesays Dr. Nancy Keating, a professor of health policy at Harvard Medical School.
“We don’t know the outcome it will be better‘ said Keating. “We don’t know if the additional image processing would do more good than harm.”
Additional image processing — such as ultrasound or MRI — take a risksaid Garber. both tests This may lead to “false alarms”. In this case, benign tissue is flagged as suspicious.
False alarms can lead to invasive biopsies, which can cause pain and bleeding as well as stress and stress. unnecessary follow-up testssome of them are with additional radiation exposure or dye to dye it may cause side effects and allergic reaction.
In some cases, additional screening tests can result in women being diagnosed and treated for cancers they would not otherwise have had, a problem known as overdiagnosis or overtreatment.
A study published in 2022 estimated that 15% of breast cancers detected on mammograms occur in women aged 50 to 74. It was overdiagnosed. Ruth Etzioni, a biostatistician at Fred Hutchinson Cancer Center and co-author of the study, points out that not all cancers are the same. Some aggressive tumors grow quickly and require immediate treatment, while others grow too slowly to harm a woman during her lifetime. Older women diagnosed with slow-growing breast tumors may die from other causes before the cancer causes problems.
some research too question the reliability A system used to label breasts as dense or dense. According to a review article in the Annals of Internal Medicine, 13% to 19% of women Reclassified into a different breast density category Subsequent screening mammograms may change from dense to non-dense or vice versa.
Chrissy Matos said she had her first mammogram at age 40, but received her first notification of dense breasts this year at age 42. Matos, who lives in Stroudsburg, Pennsylvania, said she wonders why her breasts didn’t look dense on her first mammogram. Breasts tend to be denser in younger women.
Doctors recommended a second mammogram, this time using a new technology known as digital breast tomosynthesis (also known as 3D mammography). Matos said the ultrasound revealed that the suspicious areas on the mammogram were not a cause for concern.
The high cost of advanced imaging puts it out of reach for many patients. Women from the countryside, marginalized communities often inaccessible To the latest technology.
Gerber, the Loan Institute analyst, said the FDA’s language is misleading. It is true that there are women with big breasts, The probability is 1.5 to 2 times than other women develop breast cancerthey There’s no more chance of dying after that.
The FDA’s notice language generally “kind of encourages people to get more tests when in fact they’re not recommended,” Gerber said. “So the FDA is saying, ‘Now that you have this breast density, you need to be aware that there are additional risk factors.'” But there’s nothing people should do about it. It’s a really terrible place to be a patient. ”
The FDA’s Marston said she hopes women and their doctors can use the concentration notifications to have informed conversations. “We certainly don’t want to hide information from women,” Marston said.
Given the uncertainty about the benefits of additional screening tests, Perlman said the “safest and probably most accurate” way to advise women with dense breasts is because “what is best practice at this time is “I don’t know for sure,” he said.
Mullen said she was relieved that an insurance-covered follow-up test found nothing suspicious. But “breast cancer is always on my mind because of my family history,” Mullen said. She knows her breasts are dense, so “I think I would have been nervous if I hadn’t had the ultrasound.”
