Dense Breasts: What You Need to Know
Women are learning more about breast density these days because it's now state law that they are notified by a written letter if they have dense breasts on their mammogram. Amy Fitzpatrick, MD, of BMC's Belkin Breast Health Center points out that having dense breasts is normal, about 1 in 2 women having a mammogram will be informed that they indeed have dense breasts.
Dr. Christine Gunn is a Research Assistant Professor in the School of Medicine and Public Health at Boston University. BMC is the primary teaching affiliate for Boston University School of Medicine. Her research focuses on cancer prevention and control and is primarily conducted within the Women’s Health Unit in the Section of Internal Medicine.
Learn more about Dr. Christine Gunn
Dr. Amy Fitzpatrick is an internal medicine physician at BMC. She has special interests in women’s health, addiction medicine, and primary care.
Learn more about Dr. Amy Fitzpatrick
Melanie Cole (Host): Women are learning more and more about breast density these days because it’s now a law in many states that they are notified by a written letter if they have dense breasts on their mammogram. My guests today are Dr. Amy Fitzpatrick – she’s an Internal Medicine Physician at Boston Medical Center -- and Dr. Christine Gunn – she’s an Assistant Research Professor in the School of Medicine and Public Health at Boston University. Welcome to the show, ladies. So, Dr. Fitzpatrick, I’d like to start with you. What does it mean to have dense breasts?
Dr. Amy Fitzpatrick (Guest): Breast density describes how the breasts look on mammogram. Breasts are made up of different tissue, and fat. The tissue is made up of milk ducts, glands, something that we call connective tissue, which holds everything together, and also fat. Breast density compares the area of the breast and connective tissue to the area of fat in the breast, and so that ratio is something that they can see on mammogram, and that’s what dense breasts mean.
Melanie: Are there risks, Dr. Fitzpatrick, associated with dense breast tissue?
Dr. Fitzpatrick: Yes, there can be. Having dense breasts can be a risk factor for breast cancer, and then the other way it plays a role in breast cancer screening is that dense breasts can – because the areas in the breast that have -- the tissue part – they show up white on a mammogram. Sometimes tumors and breast cancer can also show up white, so it can make it difficult to see underlying masses on mammogram.
Melanie: Dr. Gunn, if a woman starts her mammograms at 35 or 40, whenever she starts – and the radiologist detects that she does have dense breast tissue, now in some states, it’s actually a law that she get a letter about this. Speak about what that letter is and how did that come to be implemented?
Dr. Christine Gunn: The laws that are in now 27 states around the country started in Connecticut back in 2009, and there was a woman there named Nancy Cappello, and she had her annual mammogram like many of us do, and when she got her results, they said they were normal. Within a year she was diagnosed with an invasive breast cancer, and her doctor said, “Well, that’s because you have dense breasts.” She really felt, at that point, that it was important that she should have been informed about her breast density. She started an advocacy movement, first in Connecticut and then around the country, trying to get some transparency in these written letters, mandating that when a woman has dense breasts on a mammogram that they are then notified, and the way that this is rolled out is via written letters. So the radiologist or the facility where you have your mammogram is now required to send out a letter with your result, that tells you whether you have dense breasts. In Massachusettes, they’re required to talk about eight different components, telling you-you have dense breasts, what that degree of density is, that it does increase your risk for breast cancer, that it may mean that it’s harder for mammograms to see your tumor on the mammogram, and then that you can talk to your doctor about potential options for supplemental screening with other things besides the mammogram that may benefit you.
Melanie: Dr. Gunn, in some states, the law goes a little further by requiring health providers to offer this supplemental screening. Does it say that in the letter, or does the letter just let you know maybe the amount of density? When should women be worried about this letter?
Dr. Gunn: It depends on -- it really varies state-to-state on what is required. Some of the letters mentioned like you said, that you might need supplemental screening. Some mention that there are potential options, but they don’t necessarily recommend them. Others don’t mention these supplemental screenings at all. I think the point of many of them is that you should talk to your doctor about your individual risk, and not just base everything on density, although, these other tests are out there that may benefit you, but it really depends on a lot of different factors independent of each individual woman.
Melanie: Dr. Fitzpatrick, what are some of the supplemental screening recommendations that might be available for a woman with dense breasts?
Dr. Fitzpatrick: The two most common are the whole breast ultrasound, and the second one, which we use at Boston Medical Center is the breast MRI, and those are the two additional screenings that we use for women with dense breasts.
Melanie: So what does that mean for a woman? It’s a better view, obviously, but as far as insurers go, and for you doctors, is this just a clearer view? Do you get a deeper meaning of what’s going on in there? Is this something that will be paid for every year?
Dr. Fitzpatrick: It does, it offers a different view. It’s another way of looking at the breast tissue where they can sometimes see a little bit better for women with dense breasts. Unfortunately, the insurance piece is – because this is new legislation, and there’s still a lot of research being done in the area, not all insurance companies do cover the supplemental screening. The reason we tell women to talk to their doctors is that it’s helpful for a doctor to do a breast cancer risk assessment to help women decide whether they need supplemental screening or whether they can feel comfortable just with their mammogram.
Melanie: And Dr. Fitzpatrick, what about a self-exam? Does dense breast tissue impede a woman’s ability to give herself a good, thorough self-exam every month?
Dr. Fitzpatrick: No, it actually doesn’t. We still encourage women who are doing self-breast exams, to continue to do their self-breast exams. Actually, breast density is a radiologic finding. It’s something that determines after a woman has had a mammogram, so you can’t tell from doing a breast exam of how dense a woman’s breasts are, so we still would encourage women who are getting clinical breast exams or self-breast exams that they continue to do so because it really is a finding that’s determined by their mammogram and not by breast exam.
Melanie: Dr. Gunn, what would you like to tell women that receive this letter after a mammogram about not panicking, and following through with their provider?
Dr. Gunn: I think that’s a good point. We’ve spent a lot of time talking to women who have received these letters since the law went into effect in Massachusetts in 2015. A lot of women do panic, so I would encourage them to stay calm. Breast density is one of many risk factors for breast cancer. It alone, will not determine whether you have cancer, so the important thing is to follow up with your primary care provider -- or a provider whom you feel comfortable with – to discuss where your breast density fits into your overall risk before you worry about that it’s definitely going to lead to something like cancer.
Melanie: And Dr. Fitzpatrick, the last word to you, tell women what you want them to know about mammograms, the importance of working with their provider, especially if they have dense breasts.
Dr. Fitzpatrick: I think the one thing I would like to stress to women has dense breasts is not abnormal. One in every two women have dense breasts, and I think that women are frightened when they get the letter, so the first thing that I say to them is that this is not abnormal. One in every two women have it, and it is important to talk to your doctor because although dense breasts are a risk factor for breast cancer, there are many risk factors for breast cancer. Doing a risk assessment and taking a look at the other risks that you have, your doctor can help you put this into perspective and to help you feel more comfortable getting your mammogram and understanding what it means.
Melanie: Thank you, so much, it’s great information and so important for women to hear. Thank you, ladies, for being with us today. You’re listening to Boston Med Talks with Boston Medical Center. For more information, you can go to BMC.org, that’s BMC.org. This is Melanie Cole. Thanks, so much, for listening.