New US Regulation Mandates Notification of Breast Density After Mammograms

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When a woman undergoes a mammogram, the primary objective is to detect any signs of breast cancer. The secondary, yet crucial, aspect is determining the density of her breasts. Since early September, a new U.S. regulation mandates that mammography centers notify women about their breast density, though several states already had similar requirements in place.

Understanding breast density is essential. Dense breasts are not abnormal; in fact, they are quite common, with about 40% of women aged 40 and older having dense breast tissue. This condition is independent of a woman’s shape or breast firmness and mainly matters in the context of breast cancer screening. Dr. Ethan Cohen from MD Anderson Cancer Center in Houston explains that with the new rule, many women may seek explanations from their doctors or look for information online. He emphasizes that there’s no need to panic.


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Breast density is determined by doctors who analyze mammograms using a classification system with four categories. The least dense category signifies breasts composed almost entirely of fatty tissue, while the most dense category indicates that the breasts are mostly glandular and fibrous tissue. Breasts fall into the dense category if they are classified as “heterogeneously dense” or “extremely dense.” The other two categories are considered not dense. Dr. Brian Dontchos of Fred Hutchinson Cancer Center in Seattle notes that this classification can be subjective, varying based on the doctor’s interpretation of the mammogram.

Women are informed about having dense breasts for two primary reasons. First, dense breast tissue makes it more challenging to detect cancer on a mammogram, as both cancer and dense tissue appear white on the X-ray image, akin to spotting a snowball in a blizzard. Dr. Wendie Berg from the University of Pittsburgh School of Medicine highlights this difficulty. Second, women with dense breasts face a slightly higher risk of developing breast cancer, as cancers are more prone to form in glandular and fibrous tissue. However, it is reassuring to note that having dense breasts does not correlate with an increased mortality rate from breast cancer.

If you are informed that you have dense breasts, it is advisable to discuss your family history of breast cancer with your doctor to determine if additional screening like ultrasound or MRI is necessary, suggests Dr. Georgia Spear of Endeavor Health/NorthShore University Health System in Chicago. Researchers are actively seeking better methods to detect cancer in women with dense breasts, but currently, there isn’t enough evidence to universally recommend additional screening. The U.S. Preventive Services Task Force has called for more research in this area in its updated breast cancer screening guidelines earlier this year.

Despite having dense breasts, regular mammograms remain essential. They are still the gold standard for early cancer detection. Dr. Spear stresses that mammograms should not be replaced but supplemented with additional tests if needed. Women, transgender men, and nonbinary individuals at average risk should begin mammograms at age 40.

The coverage of additional screening by insurance is still variable. There is a bill introduced in Congress aimed at requiring insurers to cover the cost for women with dense breasts. The additional screening can be costly, ranging from $250 to $1,000 out of pocket, posing a financial barrier for many. Dr. Berg underscores the importance of ensuring that every woman has an equal opportunity to detect cancer early when it is most treatable, which she describes as the bottom line.