What should we do with dense women?
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Women with dense glandular breast tissue present a challenge—and one with high stakes.
Their tissue type is capable of hiding small abnormalities, they have a documented increased risk of breast cancer, and should they have a tumor it is more likely to have certain aggressive characteristics (as reported recently in the Journal of the National Cancer Institute).
As radiologists, you’re aware of these facts. But what about the women whose mammograms you interpret?
My recent post about breast density focused on the Governor of California’s decision to veto legislation that mandates that we inform “dense” women following their mammograms of their breast type and the implications, including the possible benefit of additional screening.
Similar legislation has passed or is pending in several U.S. states, but this veto highlights the importance of radiologists voluntarily providing this information.
Informing a woman of her breast density presents another dilemma. How useful is that information without recommendations on what to do next? What’s more, the medical community has yet to establish a protocol for them, including what modality should be used for follow-up.
For example, trials indicate that ultrasound combined with mammography provides increased detection in dense breast tissue. So should asymptomatic women with dense breasts be screened will full ultrasound in addition to their annual mammogram? Will insurance companies pay for the radiologist’s additional time? Can and should technologists be trained to do this screening instead?
In my opinion, we should not wait for mandates from the government to address this issue. Insurance companies, radiologists, and physicians need to work together to develop a standard of care for women with dense breast tissue. It’s a new horizon for our field—but one that will lead to brighter futures for the patients we treat.
What steps is your practice taking to notify women about the risks associated with dense breast tissue?