For women who undergo regular mammograms, test results may provide additional information about breast density.
The Food and Drug Administration’s decision took effect Tuesday requiring mammography laboratories to inform patients about their breast density, a measurement of a woman’s breast tissue.
“Mammograms have a harder time detecting cancer in dense breasts, so this is a great first step to help patients understand their risk of breast cancer and know if additional testing is needed. The national mandate would also help standardize mammogram reporting across the country, eliminating piecemeal mandates in each state.
But experts say the measure doesn’t go far enough because it doesn’t ensure that insurers will cover follow-up ultrasound or MRI scans for women with dense breasts, even if their health care provider recommends them.
Without insurance coverage, patients may delay additional testing needed to find or rule out breast cancer — and for types of cancer where early detection is key to survival, this delay can make a dramatic difference in treatment, costs, quality of life and even survival rates, medical experts say.
What is Breast Density?
Breast density measures the amount of fatty tissue compared to other tissue, called fibroglandular tissue, which makes up the muscle and milk ducts.
Women with dense breasts have more fibroglandular tissue, while women with dense breasts have more fatty tissue. Half of women have breasts that are uniformly dense or very dense. According to Memorial Sloan Kettering Cancer Center.
“Patients can’t judge breast density from its size or shape,” says Dr. Carolyn Malone, a radiologist at Hackensack University Medical Center in New Jersey. Breast density doesn’t change with diet, exercise, or other lifestyle factors.
“We all know that women have different breast sizes, it’s the same principle,” she says, “Your breast density is what makes you unique.”
However, as women age, they may lose breast density, especially during menopause.
Do dense breasts increase the risk of cancer?
According to the Centers for Disease Control and Prevention, women with dense breasts are more likely to develop breast cancer.
Cancer forms in fibroglandular tissue, not fat cells, says Anita Mehta, M.D., assistant professor of radiology at the George Washington University Cancer Center. The more fibroglandular tissue there is in the breast, the more opportunities there are for cancer to form, so women with dense breasts may be at higher risk of getting cancer.
Mammograms, a type of x-ray, have difficulty detecting cancer in dense breasts.
On a mammogram, fatty tissue shows up as dark on the image and fibroglandular tissue shows up as white, and cancer also shows up as white on X-rays, so experts say cancers can be hard to find if they’re surrounded by a lot of fibroglandular tissue.
“It’s like searching for snowballs in a snowy field,” says Teri Thomas, CEO of Volpara Health, a software company that helps families understand cancer risk and early detection. “Dense breasts often hide cancer.”
After a mammogram, a health care professional may recommend that women with dense breasts undergo a breast ultrasound or magnetic resonance imaging (MRI), which are more sensitive at detecting breast cancer. Both are not recommended for routine screening because they are expensive and have a higher chance of finding suspicious areas that may be misdiagnosed as breast cancer.
What to Expect at Your Next Mammogram
Women won’t notice any changes to their regular mammograms, but the FDA’s new rules will show up in their test results.
In addition to knowing if cancer has been detected, women will also be able to see an overall assessment of their breast density, ranging from “breasts are almost entirely fatty” to “breasts are very dense.”
The publication also includes a summary explaining that dense breast tissue can make breast cancer harder to detect on mammograms and increase the risk of developing cancer, and encourages patients to talk to their health care providers about breast density.
Prior to the FDA ruling, 39 states and Washington, D.C., had state laws requiring mammography labs to inform patients about their breast density or inform them generally about breast density, Mehta said. Now, the information will be uniform across the country.
However, any additional testing that may be recommended will not be covered by insurance.
Does insurance cover breast ultrasounds or MRIs?
Routine and recommended mammograms have been covered by private insurance since 2010. Passage of the Affordable Care Act; Also known as Obamacare, however coverage for additional tests due to breast density and other risk factors varies by state and insurance company.
Some insurance requires prior authorization from the medical provider, and others require patients to pay a copay before covering the test, Thomas said.
Medical experts say that because breast ultrasounds and MRIs aren’t covered by national health insurance, many women with dense breasts are forced to put off recommended tests until they can afford them. An ultrasound can cost a few hundred dollars, but an MRI bill can easily reach $1,000.
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Thomas said when patients delay screening, cancer that goes undetected by mammograms can spread, increasing the need for more aggressive treatment and worsening chances of survival.
The five-year survival rate for early stage breast cancer is 99%. According to the National Breast Cancer Foundation. By stage 3, considered advanced cancer, that rate drops to 86%.
Policymakers are looking to fix the unpredictability of insurance coverage. A bill introduced in Congress in May 2023 would: It’s called early detection.would ensure full insurance coverage for women with dense breast tissue to undergo additional testing.
The bill was supported by medical groups including: American Cancer Society and American College of SurgeonsThomas, whose company Volpara Health also supports the bill, said the extra screening for women with dense breasts is medically necessary and that the U.S. needs to catch up with other high-income countries that cover the screening.
“As a nation, we can do better,” she said. “It breaks my heart as an American that we have been so shortsighted on these issues.”
Adriana Rodriguez can be reached at [email protected].
