Page 12 - Delaware Medical Journal - March 2018
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Your Patient Got a Dense Breast Notification with Her Mammogram Report: What Are You Supposed to Do? Diana Dickson-Witmer, MD, FACS; Arvind Sabesan, MD
The Annals of Internal Medicine,
last spring, suggested the following questions that women should ask their PCP regarding breast cancer screening and prevention:1
• What is my personal risk for breast cancer?
• How often should I be screened?
• Should I be tested for the breast cancer
gene?
This article will help you answer those questions.
Many of the women reading this article will
with the report of their annual screening mammogram:
“Your mammogram shows that your
breast tissue is dense. Dense breast tissue
is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information
about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”
2003, Nancy Capello found a lump in her breast. She had stage III breast cancer. She was angry. She had a mammogram three months before and the cancer had not been seen. She began an impassioned national campaign to require radiologists to notify women when their mammogram is “dense.” She became a celebrity and legislation began
IMAGE 1
to be passed in many states.2 Unfortunately,
emotion-driven rather than science-informed
“dense?” Breasts are composed of many elements: fat, milk lobules, milk ducts, blood vessels, and connective tissue.
The lobules, ducts, blood vessels, and connective tissue collectively are called X-ray beam more than fat does. The ratio determines the mammographic density, or how white or black the breast appears on the mammogram.
A mammogram that is “almost entirely fatty” looks darker. (Image 1) A mammogram of a breast with a little more
Image 2). A mammogram of a breast with higher even whiter (Image 3), and a breast with almost no fat looks extremely white on a mammogram. This degree of density is called “extremely dense” and is present in Image 4). Younger women, still in child-bearing years, typically have less fat relative to and their mammograms are usually either “heterogeneously dense” or “extremely dense.” After menopause the glandular tissue normally begins to be replaced by
fat, a process called involution, and the mammographic density decreases. There are some exceptions. Some young women, who are overweight and have a high BMI, may have less dense breasts. Some post- menopausal women with very low BMI,
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Del Med J | March 2018 | Vol. 90 | No. 3
