Should doctors notify women that they have dense breasts?
An article of interest from The Atlantic:
http://www.theatlantic.com/health/archive/2015/04/what-dense-breasts-mean-for-cancer-risk/390729/#disqus_thread
Comments
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http://www.theatlantic.com/health/archive/2015/04/...
Made your link live.
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D'oh! Thank you, Lucy. I'll try to be better about doing that.
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I read an interesting article by a doctor who survived BC that studies show Ultra Sound is much better for diagnosing cancer in dense breasts than 2or 3D mammogram. But the tech needs to be skilled in reading them. They take longer to do so more expensive of course. Some centers are now buying automated US machines.
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I had a call back for 2nd Mammo 2 years earlier looking at same place that cancer showed up. Was most likely hard to see with dense breasts. Enough to be suspicious but then not enough to test further. A year leather I don't think the tech squished down as muchalso missing it. When something did show up in a Nov a different tech really squished them. Otherwise I'd probably still have breasts and a tumor
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I think getting a letter stating "Your mammogram was just dandy...oh, by the way, you have dense breasts" is inane, useless information. The only way any of this would be useful is if when your mammogram is the equivalent of looking for a snowflake in a blizzard, they tell you THEN, and AUTOMATICALLY immediately do an ultrasound too.
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I think we should be told, if for no other reasons then to make sure we don't decide to skip our annual mammogram. I almost did skip last year because I was busy and that's the mammogram that showed a 7 mm tumor. Glad I didn't blow that mammogram off for another year.
If I'd known I had dense breasts and that dense breasts are a risk factor for BC, no way I would have considered skipping a mammogram and I think that would be true of most people.
Only after my diagnosis was I told my 3 previous mammograms showed dense breasts. If I'd known that I might have been more proactive in trying to prevent BC with diet and exercise, I might have looked at and discussed other screening methods with my gyno, like ultrasound or an mri annually. Or I might not have done anything differently, but I think if someone has the risk factor of dense breasts they should be told about it and what this means should also be explained to them.
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I certainly would have discussed additional screening options with my PCP and maybe a specialist. Finding it before it went to my nodes (or even as DCIS) would have nade a world of difference. It still burns me that my PCP and radiologist had that information but did not have to share it with me. I am the one whose body bears the brunt of all the treatment and whose life is impacted. Why should I be the last to know???
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Also, until we're elderly virtually all of us have dense breasts (heterogeneously dense). It is really the 10% who have extremely dense breasts who are at higher risk simply from their breast density. I would imagine virtually everyipone gets this letter when they begin their screenings.
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I have always been told that I have very dense breasts, since my first mammogram at 40...I am 57...so I have always been religious about annual mammograms, and have needed extra pictures almost every year, with ultrasounds. Hopefully that is why the found it at early stage 1, with clear nodes margins.
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In CT where I live, it is the LAW to tell you if you have dense breasts so you can request additional testing if you choose (ultrasound usually) and I think a few other states are following suit. CT has had this law on the books for about 5 years I think.
http://c-hit.org/2013/10/14/ct-breast-density-screening-law-may-set-national-standard/
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I believe that it is required here in Ontario that you be informed if you have dense breasts. I was informed of this after my first mammogram in my 30's; however, I wasn't told that dense breast tissue was a risk factor for breast cancer. Just that I had dense breast tissue. So, on the one hand, the imaging centre did inform me, but, on the other hand, they didn't inform me of the significance of it.
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Reporting that you have dense breasts is the law in some states, including Minnesota. I got the reports but failed to understand the significance. I wish I had asked more informed questions about what that meant in terms of breast cancer prevention. I read that very high density can be more significant than genetics. I suspect this is due to detection issues. Mammogram only caught calcification. MRI and ultrasound found stage I cancer. When we did a double lumpectomy, my surgeons were very surprised that the cancer was twice the size they thought. The fact that density impacted detection, combined with already being high risk, was a significant part of my decision to get a bilateral mastectomy. Having mammograms gave me an artificial sense of safety. That said, I am so impressed with advances in medical technology. The difference between my experience and my mom's experience is dramatic. I am so grateful for medical researchers and pray for their continued progress. -
Ethically, yes, every woman should be told about it. New test called MBI (Molecular Breast Imaging) is much better at detecting breast cancer in dense breasts than mammos can. But its not as widely available yet. Check out this TED talk explaining the technology:
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I think I just heard a physician say it doesn't matter age or size or shape of breasts, 40% have dense breasts, and they should really have other tests other than mammogram because dense tissue looks like cancer on mammogram and that's why they don't always find it, I had a mammogram and it was clear they said but the usual dense breast statement, well now they hurt and I asked for more testing and they found something I need a biopsy. I hope women are being educated about this topic, I posted a video on this please watch.
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I hope you will take time to watch the video I posted, its very informative.
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I'm another woman who was told at my first mammogram (age 35) that I had extremely dense tissue but was not told what that meant. I think one doctor mentioned it made tumors harder to see but said nothing about it increasing my risk. At my second mammogram (age 38) I was told that again---but they still didn't tell me what that meant. They did always send me on for an ultrasound. I'm 42 (almost 43) and have IDC in my right breast now.
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