Arizona Senate Bill 1225 requiring dense breast notification became law on Oct. 1, which also marks the beginning of National Breast Cancer Awareness Month, an annual campaign to increase awareness of breast cancer and raise money for research. The new Arizona law requires health care facilities performing mammography to include a woman’s breast density classification in the summary report for mammograms that are negative. For women who are considered to have “dense breasts” according to American College of Radiology classification, the facility must tell them they have dense or very dense breasts, which can make it more difficult to identify breast cancer.
The potential impact of breast density on breast cancer risk and options for additional screening are now important parts of breast cancer awareness. So far, 19 states have enacted density-reporting laws, and legislation requiring minimum breast density reporting standards has also been introduced in the United States Senate and House.
Northern Arizona Radiology began notifying women about breast density earlier this year. The information is important because dense tissue can make breast cancer more difficult to detect. Radiologists have routinely reported breast density to patients’ referring physician for years. However, it has not been a part of the standard results letter that women receive if their mammogram is negative.
By including breast density in the patient’s mammogram report, a woman is aware that while her mammogram is negative, having dense breast tissue might make it more difficult to detect cancer. This allows the woman to discuss the pros and cons of additional screening options with her physician, resulting in a balanced, informed approach to breast cancer prevention and early detection.
According to the American College of Radiology (ACR), nearly 50 percent of all U.S. women are considered to have dense or very dense breasts, and women with dense breast tissue have an increased risk of developing breast cancer. The Susan G. Komen Foundation Risk Factors and Prevention Guide cites clinical studies showing women with dense breasts are up to five times more likely to get breast cancer, compared to women with low breast density.
Dense breasts are less fatty and have more connective tissue, which appears white like tumors, and therefore, may be more difficult to detect.
While breast density hasn’t yet been linked to an overall increase the risk of death from breast cancer, it is an important factor that can impact overall risk. Having dense breasts plus one or more additional risk factors for breast cancer may justify the need for supplemental screening after mammography.
When used in conjunction with mammography, supplemental screening tests may find hidden cancer, leading to improved early detection. Supplemental screening at NAR includes breast ultrasound, breast MRI and breast specific gamma imaging (nuclear imaging with a specialized camera and tracer injection).
Stephen V. Ward, M.D., is a board-certified radiologist at Northern Arizona Radiology