Up until September 10, 2024, states had their own rules about whether a woman should be informed about findings regarding the density of her breasts after a mammogram. Montana, Idaho, Wyoming, Kansas, Arkansas, Mississippi, West Virginia, Alaska, North Dakota, New Hampshire and Maine had not enacted laws requiring such notifications. All other 39 states had some version of letting a woman know, thought they weren’t uniform. As of this writing, the FDA is requiring that women should be informed of their breast density classification after every mammogram. Many radiology groups have done this anyway, but now it is required nationwide.
What to Know About Dense Breast Tissue
In a nutshell, breasts are comprised of dense and fatty tissue. Fatty tissue is transparent on a mammogram, but dense tissue looks solid white, so it’s harder to see through, making cancer detection through mammography harder. Dense breast tissue is also associated with a moderately increased risk of breast cancer. So, it certainly makes sense that women should be told. But then what?
What makes a woman more likely to have dense breasts? Principally, three things: youth, low BMI and hormone replacement therapy. Dense breast tissue is not an automatic red flag; it is actually common.
Here are a few things I want every woman to know:
Half of all women who have mammograms have dense breast tissue.
Dense breast tissue doesn't equate to a high risk of breast cancer. Nor does it increase the risk of dying of breast cancer.
What Are Your Options if You Have Dense Breast Tissue?
Annual mammograms are the covered standard beginning at age 40. Mammograms are the only test that has been shown to reduce the risk of dying of breast cancer.
But what about the whole “hard to detect via mammogram” risk?
Here’s the good news:
3-D mammograms give more detailed views of breast tissue and are covered by many insurance plans, including Medicare and Medicaid. Many medical centers have them and they appear better at finding cancers in patients with dense breasts. If you discover that you have dense breast tissue, ask about 3-D mammograms going forward (you may have just had one, depending on the imaging center!).
Because there is an increased risk of breast cancer in dense breasts, some women and their doctors might consider other tests. Typically, these will be ultrasounds and MRIs.
If these are recommended, there are a few things to look out for:
Unless a woman is determined to be high risk for breast cancer, these tests may not be covered and are quite expensive (especially MRIs). Make sure to ask your doctors about helping you assess your actual risk and seeking preapproval of these tests.
These tests sometimes yield false positives, though not as often as they have in the past. This can cause extra testing and stress.
Unlike mammograms, they have not been proven to decrease the risk of dying from breast cancer.
All this is to say that the new FDA rule is a step forward. Women should always be given as much information as possible about their breast health. Knowledge is power. Once you know the information, have a conversation with your doctors about the safest and smartest course for you going forward, considering all the variables – your mental health, insurance coverage profile and preferences for testing.
One thing history teaches us is that what is covered by insurance changes over time. At first BRCA1 and BRCA2 and other genetic testing was not covered by insurance. As they became a more widely used tool in cancer prevention and treatment, laws were passed requiring coverage. If testing beyond mammograms for women with dense breasts becomes standard protocol, a similar result is likely. Even if we have to wait.
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