Imaging dense breasts: Where to go from here?

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Connecticut recently passed a law mandating that women undergoing mammography screening be informed of their breast tissue density. Much discussion has followed as to whether this is a good idea for patients, and what the ramifications might be for mammography centers and women’s health providers should this legislation spread to other states.

Like many health-related bills, a compelling patient story served as its driving force… Connecticut breast cancer patient Nancy Cappello, Ph.D., received an advanced-stage breast cancer diagnosis in 2004, despite a recent “normal” mammogram that showed no signs of pathology. Her cancer was not discovered by annual mammography screening because she had dense breast tissue, which lessens the sensitivity and effectiveness of mammography screening. Underlying Capello’s personal story is known scientific fact…

  • Women with dense breasts, defined as either heterogeneously dense or homogeneously dense, have four to five times higher risk of developing breast cancer*
  • Many women have dense breasts: more than half of women younger than 50 and at least one-third of those older than 50*
  • Dense breasts present challenges for mammographic imaging, since noncalcified breast cancers are often obscured, reducing sensitivity

Opponents of the Conn. law argue that it is not purely based on science and will cause more harm than good—through increased fear and confusion among women and an increased number of unwarranted, and costly, imaging exams. While this remains to be seen, the law does pose a logical question…

What exactly should women, and their consulting physicians, do with this information?

Answering this question is complicated by the fact that radiology professionals are not always consistent in classifying breast density. Breast composition, mainly determined by the amount of breast density seen in mammograms, is typically evaluated visually. I’ve personally seen different radiologists assess the same woman with a different tissue density classification. This could be problematic!

Our research teams are developing a better method to automate the assessment of breast density using CAD technology. It’s our hope that this method will provide a more consistent and accurate measure of breast density, arming clinicians with consistent tissue density results based on precise measurement and industry standards. We’re also working on dense-tissue-based image normalization for more consistent appearance of mammographic images—to help radiologists compare prior and current mammograms more effectively and to better detect subtle changes over time. This is in addition to our continuous work to improve our mammographic image processing technology, so pathology stands out more when imaging and analyzing dense breasts.

Armed with accurate and consistent tissue density information, patients and their physicians can formulate a screening plan that is right for them.

Of course, we’re only scratching the surface here. What do think should be done to address this complex issue? Where do we go from here?

– Anne Richards, Clinical Development Manager, Women’s Health

* Berg, W.A. et al, Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA, 299 (18), 2151-2163.


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