Notifications About Dense Breasts Can Be Hard to Interpret


“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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Mammograms to Screen for Breast Cancer Could Also Give Clues to Heart Disease Risk


“Mammograms performed to check the health of the breasts could also give clues to the health of the heart, researchers say.

“That’s because the amount of calcium in the arteries of the breast, which can be seen on a digital mammogram, seems to reflect the amount of calcium in the coronary arteries, which supply blood to the heart.

“Although women are commonly screened for breast cancer with mammography, there is no routine screening test for heart disease. Calcium in the coronary arteries is known to be an early sign of heart disease. Finding a link between calcium in the breast arteries and calcium in the coronary arteries is a reason to ‘pay attention,’ study coauthor Dr. Jagat Narula from the Icahn School of Medicine at Mount Sinai in New York City told Reuters Health by email.”

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Menopause Status, Screening Interval May Predict More Aggressive Breast Cancer Tumors

“Premenopausal women diagnosed with breast cancer following biennial mammograms appeared more likely to have larger and more advanced tumors than women screened annually, according to the results of a prospective study.

“However, the proportion of tumors with less favorable prognostic characteristics appeared similar among postmenopausal women with breast cancer not treated with hormone therapy who received biennial or annual mammograms.

“ ‘The frequency at which women should receive screening mammography remains controversial in the U.S.,’ Diana L. Miglioretti, PhD, professor of biostatics at University of California, Davis, and colleagues wrote. ‘However … mammography accuracy has improved, new breast cancer treatments have been developed, and interest in tailoring screening recommendations to individual risk to maximize the balance of benefits vs. harms has increased.’ “

Mammograms May Not Reduce Breast Cancer Deaths

“Breast cancer screenings may not lead to fewer deaths but may lead to overdiagnosis, U.S. researchers suggest.

“In areas of the U.S. with high levels of screening, more tumors were diagnosed – but breast cancer death rates were no lower than in areas with fewer screenings, researchers report.

” ‘The mortality results that we observed are far from definitive,’ cautioned Charles Harding, the study’s lead author from Seattle, Washington.

” ‘The most dramatic finding of our study is the immediately evident – and substantial – evidence of breast cancer overdiagnosis,’ he told Reuters Health in an email.”

Doctor Group Seeks to Clear Confusion in Cancer Screening

“Mammograms at 40 or 50? Every year or every other year? What’s the best colon check?

“Screening for cancer has gotten more complicated in recent years with evolving guidelines that sometimes conflict. Now a doctors’ group aims to ease some confusion — and encourage more discussion of testing’s pros and cons — with what it calls advice on ‘high-value screening’ for five types of tumors.

“Too often, even the doctors who order those tests aren’t sure of the latest recommendations, said Dr. Wayne J. Riley, president of the American College of Physicians, which published the advice Monday in the journal Annals of Internal Medicine.

” ‘We want to make sure that folks get the right test at the right time for the right conditions,’ Riley said. ‘We also want our physician colleagues to try to avoid the customary, knee-jerk reaction to just test without having some sort of dialogue’ about the right choice for each patient.”

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 Informed Women Less Likely to Want a Breast Mammogram

“Women who understand the risk of over-detection and over-diagnosis associated with mammography screening have lower intentions to have a breast screening test, according to a new Lancet study.

” ‘Mammography screening can reduce breast cancer deaths but most women are unaware that inconsequential disease can also be detected by screening, leading to over-diagnosis and overtreatment,’ says study author, Prof Kirsten McCaffery of the University of Sydney.

“Over-detection and over-diagnosis refers to the diagnosis and treatment of breast cancer that would not have presented clinically during a woman’s lifetime.

“Such a diagnosis, and the resulting overtreatment, can harm women physically and emotionally.”

Interval Cancers Are More Aggressive in Non-dense Breasts

The gist: Some patients’ breast cancer isn’t detected in a mammogram, but found one year later (interval cancer). New research shows that interval breast cancer patients with non-dense breasts have more aggressive tumors than interval patients with dense breasts. They also have more aggressive tumors than women with non-dense breasts whose cancer was found by mammography.

“In a Swedish study reported in the Journal of Clinical Oncology, Holm et al found that interval cancers in women with low mammographic density breasts were more aggressive vs screen-detected cancers in these women and vs interval cancers in women with dense breasts. Use of hormone replacement therapy and family history of breast cancer were associated with increased risk of interval cancers.

“The study involved data on tumor characteristics (n = 4,091) and mammographic density (n = 1,957) from women diagnosed with invasive breast cancer from 2001 to 2008 in Stockholm…

“The investigators concluded: ‘Interval breast cancers in women with low mammographic density have the most aggressive phenotype. The effect of [hormone replacement therapy] on interval breast cancer risk is not fully explained by mammographic density. Family history is associated with interval breast cancers, possibly indicating disparate genetic background of screen-detected breast cancers and interval breast cancers.’ ”