Breast cancer screening can save lives, but there are no one-size-fits-all recommendations on when to start cancer screenings and how often to repeat the test. The right formula is particularly challenging for patients with high risk factors, such as dense breast tissue, which can make it difficult to spot early signs of tumors and increase the risk of disease.
State lawmakers took a step toward helping those patients in 2013, when they passed the dense breast notification law. As of March 1, doctors must notify patients with extremely dense breast tissue. Dr. Karen Oh, director of breast imaging at the Knight Cancer Institute, answers some common questions about what the new law means for patients and the different screening technologies available.
What is the breast density notification law?
The OHSU Knight Cancer Institute, like all health-care institutions, is now required to send a breast density notification to women if they are determined to have extremely dense breast tissue on their screening mammogram. The notice is designed to raise awareness and promote discussion between the patient and their health-care provider about the patient’s risk of breast cancer and the best screening approach.
What should patients do if they receive the notification?
The notification advises patients with dense tissue to contact their health-care provider to set up an appointment to discuss an individualized approach.
What do patients need to know about breast density?
Breast tissue is made up of both fibroglandular and fatty tissue; dense breast tissue has more fibroglandular tissue than fatty tissue in the breast. Dense breast tissue is common and not abnormal, and it decreases with age in most women. However, it can mask tumors and make it more difficult to find cancer on a mammogram. It also may be associated with an increased risk of breast cancer.
There are many breast cancer screening technologies available, which of these technologies are best for women with dense tissue?
Screening mammography is the only tool which has been shown to decrease deaths from breast cancer in large trials. According to the USPTSF, mortality drops by 17 percent when women ages 50 to 69 get screened every other year.
Other tools are available as well. Tomosynthesis (3-D mammography), recommended for women with dense breast tissue, has the potential to detect more cancers and decrease the chance of a false positive. That combination could leads to fewer follow-up tests and unnecessary biopsies. Patients should consult with their health-care provider to discuss the trade-offs. Breast MRIs, meanwhile, are recommended for women with a greater than 20 percent lifetime risk of developing cancer. However, these tests can lead to more false positives than mammography.
Where can patients learn more about breast density and breast health?
Karen Oh, M.D., is the director of breast imaging at the Knight Cancer Institute. Oh received her M.D. from the Mayo Medical School in 1998, and joined the OHSU faculty in 2007.