Doctors See a Downside to Notifying Women About Dense Breasts

Like many women, Shamma Mullen breathes a sigh of relief every time she gets good news about the results of her latest mammogram. Two years ago, however, Mullen’s doctor sent her additional information that alarmed her.

She had dense breasts.

"I had never seen a letter like that before and had no idea what having dense breasts even meant," said Mullen, 38, of Andover, Massachusetts. Mullen immediately went online to search for more information, and called her doctor with questions about follow-up tests.

Women age 40 and older in every state are now receiving notifications about their breast density along with their standard mammogram report, due to a new rule from the Food and Drug Administration. Massachusetts and 38 other states have already been sending notifications about breast density, which reflects the proportion of milk glands and connective tissue to fatty tissue.

You’ve Got Dense Breasts. Now What?

Mammogram studies show that almost half of women over age 40 have dense breasts.

Going forward, women with dense breasts will be encouraged to talk to their doctors and told that "other imaging tests in addition to a mammogram may help find cancers."

Some health advocates argue that the notifications have oversimplified a complex issue. They argue that without clear, evidence-based instructions, women could be left scared, confused and frustrated.

Judith Garber, a senior policy analyst at the Lown Institute, a nonpartisan health policy think tank, notes that there is no national standard for following up on dense breast reports.

That means women will get different advice, depending on their doctor.

"While some doctors will urge women to undergo extra tests — such as additional mammograms, ultrasounds or MRIs — others will advise women to simply continue getting regular mammograms," said Dr. Mark Pearlman, an emeritus professor at the University of Michigan Medical School, who has written screening guidelines for the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network.

"You cannot counsel an entire population of women with dense breasts with one policy that’s going to be appropriate for everybody," Pearlman said.

Benefits and Risks of Additional Screening

Part of the confusion is that experts disagree whether women with dense breasts need extra imaging.

Although the American College of Radiology and National Comprehensive Cancer Network recommend that women and their doctors consider supplemental screening, two other influential groups — the American College of Obstetricians & Gynecologists and the U.S. Preventive Services Task Force — say there’s not enough evidence of benefit to recommend additional tests.

And while additional tests can detect more cancers than mammograms alone, there’s no evidence that extra testing saves lives, said Dr. Nancy Keating, professor of health care policy at Harvard Medical School.

"We don’t know that outcomes are going to be any better" by adding more tests, Keating said. "We don’t know that additional imaging has benefits that outweigh the harms."

Additional imaging — such as ultrasounds and MRIs — carry risks, Garber said. Both tests can lead to "false alarms," in which benign tissue is flagged as suspicious.

False alarms can lead to invasive biopsies that can be painful and cause bleeding, as well as stressful and unnecessary follow-up tests, some of which involve additional radiation exposure or dyes that can cause side effects and allergic reactions.

In some cases, additional screenings can lead women to be diagnosed and treated for cancers that would never have bothered them, problems known as overdiagnosis and overtreatment.

A Critical Look at the System

Some research also casts doubt on the reliability of the system used to label breasts as dense or not dense. A review article in Annals of Internal Medicine found that 13% to 19% of women were reclassified into a different breast density category — from dense to nondense or vice versa — on their subsequent screening mammogram.

Crissy Matos said she underwent her first mammogram at 40, but received her first dense breast notification this year at 42. Matos, who lives in Stroudsburg, Pennsylvania, said she wonders why her breasts didn’t look dense on her first mammogram, given that breasts tend to be denser in younger women.

The high cost of advanced imaging puts it out of reach for many patients. Women from rural areas or marginalized communities often lack access to the latest technology.

Conclusion

In the end, the decision to undergo additional screening depends on individual circumstances. Some women may choose to have extra tests, while others may be content with regular mammograms.

It’s essential for women to be aware of their breast density and have open and informed conversations with their healthcare providers about their individual risk factors and care options.

FAQs

• What is breast density?
  Breast density is a measure of the proportion of milk glands and connective tissue to fatty tissue in the breast.
• How common is dense breast tissue?
  Almost half of women over age 40 have dense breasts.
• What are the risks of dense breast tissue?
  Dense breast tissue makes it harder to find breast cancer on a mammogram, and it’s a risk factor for cancer.
• Do I need to get extra tests if I have dense breasts?
  The decision to get extra tests depends on individual circumstances and risk factors. It’s essential to have open and informed conversations with your healthcare provider about your breast density and care options.
• Can I get access to advanced imaging if I have dense breasts?
  Access to advanced imaging may depend on insurance coverage, which may not always cover these tests.
• Is having dense breasts a reason to be worried about breast cancer?
  While having dense breasts increases the risk of breast cancer, it’s essential to stay informed and have regular screenings to detect any abnormalities early.