Page 13 - Delaware Medical Journal - March 2018
P. 13
SCIENTIFIC ARTICLE
or who are taking female hormones, may have extremely dense breasts. And there are breast density.
The distribution of levels of breast density for women of mammographic screening age dense mammograms. The remaining or heterogeneously dense. Almost all radiologists agree about entirely fatty and extremely dense.3 There is no clear objective method of differentiating between the two intermediate categories.4,5,6 One problem just to women with extremely dense breasts, but also to women with heterogeneously dense breasts. The two groups combined current method of assigning breast density observer variation, especially between heterogeneously dense and scattered
Legislators in over half of the United States were persuaded to require radiologists
to notify women of their mammographic density because there are some actual problems related to increased breast density. In mammograms of extremely
to see. This is called masking. White cancers hide in the white background. Masking is much less of a problem with tomosynthesis, or 3D mammography,
than with earlier digital mammography technology. A 2D mammogram shows all layers of the breast superimposed on one another. Tomosynthesis shows one layer at a time, so things in front of and in back of a cancer do not hide the cancer.
The other reason that lawmakers were
somewhat of a misconception. The advocacy groups state that “dense breast” is associated with high risk of breast cancer. This is not entirely true.
FACT: women with heterogeneously dense
risk of breast cancer of 1.6 compared
to women with entirely fatty breasts.
That relative risk is less than the 1.7 RR associated with having one second degree relative with breast cancer, and less than a breast biopsy.
dense breasts have a relative risk of 2.04 compared to women with completely
fatty breasts. That is less than the 2.14 RR relative with breast cancer and much less Dr. Kevin Hughes, Co-Director of the
Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital,
and mammographic density by using the concept of “residual breast density.” By
this he means the amount of breast density which exceeds what one would expect
given an individual woman’s age, hormonal status, and BMI. A 40-year-old trim Asian Olympic athlete should have an extremely dense mammogram. An overweight post- menopausal woman, not taking HRT, should not have an extremely dense mammogram, and if she does, she has a risk factor for breast cancer, over and above her age and weight.10,11
to consult with their doctor to decide which screening options are best for them. If you are the PCP, you need a valid assessment of the woman’s breast cancer risk in order important step in assessing a woman’s
risk of breast cancer is to take a careful three generation family history. This
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