I get a lot of calls about breast density on mammogram. The FDA mandates reporting of dense breasts. Often patients are being told they need additional testing because of that finding. I have tried to identify good science to help my patients decide what to do.
The American College of Obstetricians and Gynecologist does not recommend routine use of alternative or adjunctive tests to screening mammograms in women with dense breasts who are asymptomatic and have no additional risk factors.
Dense breasts make identification of early breast cancer more difficult. However, published studies show no benefits of these added tests for breast cancer mortality.
A woman over 40 should consistently get yearly mammograms so early detection is possible.
One screening assessment called the Tyrer-Cuzick profile has been used to recommend additional screening when the risk exceeds 20%. But that level does not appear to be accurate enough to make it cost effective. Some experts say the T-C profile overestimates risk.
A lot of my patients report being pushed into additional screening. This predatory money-driven practice creates unwarranted anxiety in those with less financial resources.
What should a woman do when advised to have additional testing?
If your mother, her sister(s) or your sister(s) have had breast cancer, especially before age 50 or you have biopsy proven high risk tissue then definitely consider ultrasound and/or MRI. Remember these tests are not screening and are not covered by insurance.
If you are told you need an MRI or ultrasound because your Tyrer-Cuzick profile risk is above 20% go back to family history to decide. I am always happy to sit down and discuss risk with my patient.
If you have the financial resources, then additional testing is not as daunting as for a woman with limited income. Without a strong family history or biopsy proven high risk tissue I recommend just getting a yearly screening mammogram.
If a 3-D mammogram is available for screening it is more sensitive at picking up early breast cancer in dense breasts.
