State of North Carolina now requires mammography reports to include breast density information
On July 23rd, 2013, Governor Pat McCrory signed a law to standardize dense breast tissue reporting to women. North Carolina joins several other states to standardize dense breast tissue reporting. Addy Jeffrey, Greensboro, North Carolina resident, brought the issue of dense breast to the legislature after her advanced stage cancer diagnosis within 8 months of a normal mammogram.
The legislation is designed to improve breast cancer detection and prevention through educating patients about dense breast tissue and how it can conceal abnormalities during mammographic procedures, and encourages patients to actively participate in their screening surveillance protocol with their healthcare providers.
Seven additional states have legislation pending in the 2013 session. Additional states may file similar legislation in 2014 session.
For more information, visit www.areyoudense.org
Frequently asked questions
How common is it to have dense breast?
Dense breast tissue is common and is not abnormal. 50 percent of women will fall into one of the two dense breast categories, heterogeneously dense or extremely dense. The determination of density is a qualitative visual assessment performed by the interpreting radiologist
Does having dense breast tissue increase my risk of cancer?
Breast density is not a major cancer risk factor. However, the sensitivity to mammography is reduced as density increases making it harder to identify abnormalities within the breast. It would be a benefit for women with dense breast to complete a risk assessment with their physician. It is a good starting point in the discussion of whether supplemental tests will be beneficial and what tests, if any, to order.
Should I continue to get mammograms if I have dense breasts?
Yes. Mammography is the only screening tool that has been demonstrated through large randomized trials to lower breast cancer mortality. Also, mammography is the only test that can reliably detect suspicious calcifications. Such calcifications are often the first sign of in-situ cancers, which coexist with otherwise invisible invasive cancers. Other screening options are available, but should be considered in addition to regular screening mammography.
Are there other screening options for women with dense breast?
Among the additional tests that are available, screening breast MRI and 3D breast tomosynthesis are impacted less by breast density in their ability to detect cancer than 2D mammography alone.
Which additional screening option is right for me?
Breast MRI: Screening breast MRI has been shown to substantially increase the rate of cancer detection, more so than screening ultrasound and breast tomosynthesis. However, unless you have additional risk factors and are considered at high risk of getting breast cancer, your insurance will most likely not cover the cost of the exam.
Current data suggest that breast tomosynthesis may increase breast cancer detection with significantly less false positives. As such, tomosynthesis ultimately may be shown to be a better screening test than standard mammography. However, we await more robust evidence on its benefits and limitations.
What if I have dense breast tissue and have other risk factors?
In high risk women, supplemental screening tests are recommended in addition to mammography. Studies support the use of screening MRI in women who are known to have a very high risk (>20% lifetime or >5% 10-year) of breast cancer, regardless of their breast density. Screening breast MRI is typically covered by insurance for high-risk women only.