Approximately half of women age 40 and older have dense breast tissue – meaning more fibrous and glandular tissue than fatty tissue.
It’s a risk factor for developing breast cancer. However, breast density can also make detecting the disease difficult.
KERA’s Sam Baker talks about this with Dr. Kaitlin Bokhari, a breast oncology surgeon with Baylor Scott & White and Texas Oncology.
Dr. Bokhari: Having denser breast tissue can make mammograms less sensitive because the way that a mammogram image is taken, the mammogram takes the x-ray and passes it through this tissue in order to take the picture. And the denser your breast tissue is, the more likely it is that image could be a little bit less sensitive to pick something up. Essentially what we say is it could it can hide things inside the dense breast tissue that mammogram’s just not ultimately able to see.
Baker: Certainly over the years we’ve had improvements with imaging, I’m thinking 3D mammography. How does that stand up to breast density today?
Bokhari: It’s helped quite a bit, but it hasn’t been able to completely erase the complicating factor of still there are some women whose breath tissue is too dense to be adequately imaged by mammography alone.
Baker: So, what happens when that occurs?
Bokhari: So, there’s actually a law in the state of Texas called Henda’s Law.
It states that any woman who has dense breast tissue should be sent a letter after their screening mammogram is read and sent to them that notifies them that they do have dense breast issue and that they may be at risk of their mammogram not being as accurate.
And so it does qualify them for additional imaging outside of mammogram, even outside of 3D mammogram. And so if they speak with their primary care providers, most of these women can go on to have additional supplemental screenings, which is most often done with either complete breast ultrasound or breast MRI. And MRI is really the gold standard because it’s not subject to density.
Baker: With the notifications, the supplemental screening, are we detecting more cases of cancer?
Bokhari: I certainly think that the supplemental screening is working. I think we are able to better screen our high-risk patients. We’re certainly able to detect more of what we would consider like high-risk things, which again, the detection of cancer, certainly, yes, but even things that are pre-cancerous that still need to be managed. We are able better to detect those early as well.
The key to breast cancer care is early detection of both breast cancer and its cursors. So, I do think it is working to have our patients who we know are at higher risk of breast cancer go through this higher risk screening process.
Baker: You mentioned additional options. Are those the options or are there others?
Dr. Bokhari: There are some newer advents in the world of breast radiology, but they have not been formally written into guidelines yet. So that would be very exciting to see how those change in the coming years with some of these newer technologies that are being researched and brought into the availability.
Baker: Was there more that you wanted to cover along this line in this topic?
Dr. Bokhari: I mean, I think that women who have dense breast tissue should definitely talk with their providers to see if they should be referred for conversations about this additional screening. I do think it’s very important for women to know their own history, their family history, and certainly do their annual mammograms.
I also think that women who have any questions whatsoever should not feel hesitant to talk to their doctor, which I know is always something that I hear. Patients say they don’t want to ask silly questions, but really there’s no silly question when it comes to our breast health.
Baker: Ask all questions that you could possibly think of?
Dr. Bokhari: Yes, if you have any concerns, you should always bring them up.
RESOURCES:
Dense Breasts: Answers to Commonly Asked Questions
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