Heterogeneously Dense Breasts

ruthiew

I noticed that some women have mentioned that they received an ultrasound instead of or in addition to a screening mammogram due to having dense breast tissue. I have heterogeneously dense breasts, but my physician never seems to think this is necessary. Even two years ago during a callback for focal asymmetry (benign), four images were taken without any ultrasound. When I asked why, I was told that each picture revealed that the area was less of a concern, and that the radiologist was looking for specific views to make her final recommendation.

Last year, my screening mammogram came back as benign stable architectural distortion, Birads 2. (Screening mammograms are done/ read at various outpatient locations, but callbacks are done at a breast care facility) Knowing that asymmetry and distortion are not the same, I had the radiologist at the breast care center review last year's films, and she agreed that there had not been any changes. So two years ago I had focal asymmetry, last year the same area was called a distortion. This year everything continues to be stable. I guess my question at the end of all this is how do doctors determine when it is appropriate for a woman with dense breasts to have an ultrasound as part of her annual breast care routine?

Thanks for the information, and for reading all this.

Gussy

after having "normal" mammograms for decades with mention of dense breasts every time, several lymph nodes showed up on my annual mammo in 2017. No follow up of any kind had ever been suggested. It required an MRI to determine that I had a 6 cm tumor in my L breast that had probably been there for 10 years according to my breast surgeon. It was not seen even on US. If you have any question about your dense breasts insist on an MRI. It is the gold standard for dense breasts

MinusTwo

After more than 35 years of mammograms, always with a call back for diagnostic mammo & ULS every singe time, finally something appeared that they felt need a biopsy. Because it had been so many years with 'nothing there', I told the radiologist she must be wrong. She was pointing out 'scar tissue' and I'd never had a biopsy. So 35 years of dense breast exams before a biopsy showed DCIS.

Who orders your mammograms? My OB/Gyn ordered mine. Who meets with you about the results? A radiologist always met with me, and then my OB/Gyn reviewed and concurred. If you've never had anything pop out and your reports are "no change", you may just have dense breasts. But you could certainly push for an ultrasound as the next step. However your insurance may not pay for it.

Rah2464

I began having mammograms at age 30 after having a lump removed that was ADH. Dense breasts always. Even began having the lauded 3D mammograms whenever they first became available. It wasn't unusual to get a callback to have an ultrasound. This was under the care of a breast center with a review with a breast surgeon. I went religiously, every year.

My cancer hid for who knows how many years as it was close to my chest wall. The only imaging that spotted it was an MRI. I couldn't feel the lump either, I just saw a new breast surgeon who believed me when I told her something wasn't right and she ordered the gold standard MRI test.

Please push for a baseline MRI if nothing else.

bcincolorado

Because of my history and having mx on my left side when I had my mamo on my right last month had extra pictures done (3D) and they read them right away as well at my center. Then they made me go in for an ultrasound too because there was an area they were unsure of because of dense tissues. The ultrasound determined a cyst and ok for now.

MinusTwo

Ruth - I looked back at your posting history and it seems you've been worried since 2018. You've been diagnosed clear each time. Please do go back and read what Beesie answered on one of the other threads you started.

From a quick review, it looks like you have never been diagnosed with cancer. Also you asked in your posts every year about having an ultrasound - but I don't think you ever pursued that - is that correct? If so, I would focus next on getting an ultrasound to supplement your clear mammos. I believe that would be the next logical step. Based on those results added to you existing records, you can push for an MRI if you still believe there is something wrong.

ruthiew

Thank you ladies for the insight and advice. My PCP orders my mammograms. I have had two callbacks, one in 2006, and one in 2018. In 2006 the radiologist discussed my results with me(just a dark area that needed a clearer image), and in 2018, the radiologist read the diagnostic mammogram immediately, but the technician was the one who told me the results of testing. I have requested an ultrasound for the last three years due to having dense breasts, voicing my concerns with my PCP and also with our community's dedicated breast health center.

I read that our state just passed legislation stating that insurance must pay for supplemental breast testing for women with extremely dense breasts. Women with heterogeneously dense breasts qualify for supplemental testing only if they have a family history or genetic concerns. So according to the new law, I do not qualify. I could always pay out of pocket, but I guess I was just wondering if/how some of you were able to convince your physicians to authorize an ultrasound or MRI solely based on the presence of heterogeneously dense breasts.

Beesie

ruthiew, I'm in Canada so it may be different here, and since health care is provincial, even here it may be different by province. But my experience is that in Ontario, you can request or will be offered a supplemental ultrasound, or possibly even an MRI (especially for those with a personal history of breast cancer) if you have extremely dense breast tissue, but not if you have heterogenously dense breast tissue.

The thing you have to keep in mind is that heterogeneously dense breast tissue is normal for premenopausal women and still very common even for post-menopausal women. So adding ultrasounds for those with heterogenously dense breasts would mean adding ultrasounds to approx. 1/2 of all screenings. It's also important to note that all stats on breast cancer rates by age and all the stats on the effectiveness of mammograms (or lack of effectiveness, for those with extremely dense breast tissue) have the high rate of heterogeneously dense breast tissue already baked into the numbers.

Based on this, I think most Radiologists use judgement - if someone is near the top of the heterogeneous range and the mammogram image isn't very clear, then the Radiologist may offer up or suggest an ultrasound. But for those who have heterogeneously dense breasts at the lower end of the range, or if the higher density is scattered and the imaging appears clear and easy to read, then the Radiologist may assess that an ultrasound isn't necessary. It sounds to me that this is the judgement that the Radiologists have made in your case. It appears that a couple of different Radiologists have reviewed your mammogram imaging over several years and they are satisfied that asymmetry / distortion is stable and not a concern.