Notifications About Dense Breasts Can Be Hard to Interpret

Excerpt:

“About 40 percent of women who have mammograms are found to have dense breast tissue, a normal finding that can make it harder to detect cancer. But many of these women receive letters in the mail about the finding that can be hard to decipher, a new study found.

“ ‘Twenty percent of the population only reads at an eighth-grade level, and many more don’t read at a much higher level than that,’ said Nancy R. Kressin, one of the study’s authors who is a professor at Boston University School of Medicine and a senior researcher at the Veterans Affairs Boston Healthcare System.

“ ‘For many women, these notifications are not going to be easy to read’ and might even be alarming, she said. ‘We’ve talked to some women who received these letters, and their reaction was “Oh my God, I have cancer.” ‘ ”

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Study Suggests Dense Breast Tissue Isn’t Always a High Cancer Risk

“A new study offers help to patients and doctors who are trying to deal with mammogram results that many women consider troubling and confusing: the finding of ‘dense’ breast tissue.

“Not only is breast density linked to an increased risk of cancer, it also makes cancer harder to detect because dense tissue can hide tumors from X-rays. But the new research indicates that not all women with dense breasts are at very high risk.

“Patient advocates urge women with dense breasts to ask doctors about extra tests like ultrasound or an M.R.I. to check for tumors that mammography might have missed. Studies have found that those exams can improve detection of tumors over mammography alone in dense breasts.

“Pressed by advocacy groups, 22 states have passed laws requiring that breast density be reported to mammography patients, and similar federal legislation has been introduced in the House and the Senate.”


Ultrasound Lags behind MRI for Supplemental Breast Cancer Screening

“Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women 40 years of age or older have dense breast tissue, making supplemental breast cancer screening essential.

“Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.

“According to Ellen B. Mendelson, professor of radiology at Northwestern University Feinberg School of Medicine, and Wendie A. Berg, professor of radiology at Magee-Womens Hospital of UPMC, a significant factor is lack of available intensive training opportunities.

” ‘The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,’ say Drs. Mendelson and Berg. To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.’ “


Better Mammography Technique for Women with Dense Breast Tissue

“A new breast imaging technique pioneered at Mayo Clinic nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue, according to the results of a major study published this week in the American Journal of Roentgenology.

“Molecular Breast Imaging (MBI) is a supplemental imaging technology designed to find tumors that would otherwise be obscured by surrounding dense breast tissue on a mammogram. Tumors and dense breast tissue can both appear white on a mammogram, making tumors indistinguishable from background tissue in women with dense breasts. About half of all screening-aged women have dense breast tissue, according to Deborah Rhodes, M.D., a Mayo Clinic Breast Clinic physician and the senior author of this study.

“MBI increased the detection rate of invasive breast cancers by more than 360 percent when used in addition to regular screening mammography, according to the study. MBI uses small, semiconductor-based gamma cameras to image the breast following injection of a radiotracer that tumors absorb avidly. Unlike conventional breast imaging techniques, such as mammography and ultrasound, MBI exploits the different behavior of tumors relative to background tissue, producing a functional image of the breast that can detect tumors not seen on mammography.”