Summary: A new FDA regulation requires all U.S. mammography facilities to notify patients of their breast density levels, prompting radiologists to play a critical role in educating patients about the associated cancer risks, the need for additional screening options, and how breast density changes over time.

Key Takeaways

  • Breast density is a significant risk factor for breast cancer because it can mask abnormalities on mammograms and increases the risk of developing cancer by four to six times.
  • Breast density can only be diagnosed through imaging, not physical exams, with patients categorized into four levels based on their density, potentially requiring additional screening.
  • Supplemental screening methods like ultrasound or MRI are recommended for women with dense breast tissue to detect masses missed by mammograms, though insurance coverage for these tests may vary.

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This month, a new U.S. FDA regulation requires all U.S. mammography facilities to notify patients of their breast density levels. Although many centers have already been doing this, the regulation now mandates this practice nationwide. The updated standard offers an opportunity for radiologists to play a crucial role in educating patients about breast density and its implications.

1. Breast density as a risk factor for breast cancer

Breast density, the ratio of fibrous to fatty tissue, is a key factor in cancer risk. Dense breast tissue can mask small masses on mammograms, as both dense tissue and cancerous changes appear white, making it difficult to detect abnormalities.

Georgia Spear, MD, chief of breast imaging at Endeavor Health/NorthShore University HealthSystem in Chicago, notes that dense tissue is like “looking at a cloudy sky,” obscuring potential issues. Increased density also correlates with a four to six-fold higher risk of breast cancer, likely due to the abundance of glandular and fibrous tissue where cancer is more likely to develop. This regulation supports personalized risk assessment, encouraging additional imaging methods like ultrasound or MRI.

2. Breast density diagnosis through imaging

Breast density can only be determined through imaging, not physical exams. Radiologists will categorize density into one of four levels: entirely fatty, scattered fibroglandular, heterogeneously dense, or extremely dense. Patients with heterogeneously dense or extremely dense tissue may require additional screening.

3. Benefits of supplemental screening

For patients with high breast density, additional screening methods such as ultrasound or MRI can help detect masses missed on a mammogram. As Lora D. Barke, DO, FACR, chief of breast imaging at Invision Sally Jobe in Denver, explains, density is just one of several factors considered when recommending further tests. While mammography remains the gold standard, these additional modalities provide a more comprehensive view, especially in dense tissue cases. However, insurance coverage for these tests varies, complicating access for some patients.

4. Breast density changes over time

Breast density can fluctuate with age and hormonal changes. Radiologists regularly monitor density during routine mammograms to track any changes over time. Jocelyn Rapelyea, MD, associate director of breast imaging at GW Medical Faculty Associates in Washington, D.C., emphasizes the importance of discussing breast density with patients to determine the most appropriate screening plan.

Radiologists are key to helping patients understand these new regulations and the implications of breast density on their overall screening strategy.