Confused about most recent Mammo

I have not been told this previously, is this something to be concerned about that it changed?

If this is your 3rd mammogram the reports of the prior two should have indicated your density. Did the prior reports say fatty or scattered?

Also, should I assume this applies to both breasts since it wasn't specified R or L?

Yes both.

If I have Category D density, can I rely on these findings?

"The breast density is extremely dense, which lowers the sensitivity of mammography" and this has always been the case for small abnormalities. The more priors you have to compare, the more likely it is to find a small abnormality early on in each subsequent mammo.

Should I do an ultrasound or MRI in addition to an annual mammogram should I just insist on this going forward?

Some states have laws that make it easier to get the additional screening exams for density. Not sure which ins companies will pay for them without question but some will.

Should I ask for them to go ahead and look at the left breast if density is compromising mammogram findings?

It has to be ordered as a bilateral exam by your doc if you want the other breast evaluated on US as well

Just a quick comment on MRI of the breast in general

The value of cross sectional imaging modalities is based on their ability to show us the cancer and this ability relies on the two main physics-dependent attributes of each of them: contrast resolution and spatial resolution.

The advantage of MRI in finding breast cancers is its ability to show a larger difference between the signal of the mass and the signal of the background making it more conspicuous to the reader. This is contrast resolution.

Cat Scans are high in spatial resolution and lower in contrast resolution, especially without contrast. If you want to see if a bone mass has sub-mm thick septations in it, or want to see highly detailed images of facial fractures, CT is the way to go. The difference between the interiors of two similar soft tissue masses is less clear.

In MRI of the breast, things that are 5mm and smaller all look alike. The problem is normal glandular tissue looks like large collections of 5mm enhancing nodules so if you have a 5mm or smaller cancer and dense breasts it is possible that it might be like trying to find a ping pong ball in a basket of golf balls... while squinting. The good news is a 5mm or smaller cancer is not life threatening. Statistics show there is little or no difference in prognosis when the cancer is first discovered up to 1.4cm in diameter according to a lecture i attended given by László Tabár (the world's foremost expert on mammo).

djmammo:

Thanks for the information. Do you know how many Teslas the 5mm limit was for?

WC3

It applies to MRIs in general. I believe the 3.0T units have better spatial resolution than 1.5T units but its still not good enough to tell a 5mm mass from a 5mm spot of normal tissue in extremely dense breast if the density is due to enhancing normal tissue If the breast is extremely dense due to abundant fibrous tissue, its less of a problem. This is why we try to schedule the scans during a part of the cycle when the hormonal stimulation is lowest.