Mammogram Reports Must Now Include Info on Breast Density
Beginning this week, all mammography reports and result letters sent to patients in the United States will be required to include an assessment of breast density. The update is from the Food and Drug Administration’s decision to amend the Mammography Quality Standards Act.
According to Kimberly Funaro, MD, a breast radiologist in the Diagnostic Imaging and Interventional Radiology Program at Moffitt Cancer Center, breast density refers to the way different types of breast tissue appear on a mammogram. Dense breasts typically have more glandular and fibrous connective tissue and less fatty tissue.
“Dense breasts may limit the sensitivity of mammography,” Funaro said. “In addition, having dense breasts increases the risk of developing breast cancer.”
While the new requirements involving notifications begins this week, there is not a requirement to provide specific next steps available for patients with dense breasts. And just because a woman learns she has dense breasts doesn’t mean she should be immediately alarmed.
“It’s important to remember that half of all women will have dense breasts,” Funaro said.
So, what steps should a woman take if she learns through one of these letters that she has dense breast tissue?
“She should discuss her results with her health care provider, as well as any additional risk factors she may have,” Funaro said. “Depending on the degree of risk from dense breasts, in addition to other risk factors, there may be recommendations for supplemental screening, or screening performed in addition to mammography, such as breast MRI.”
Research shows that MRI exams find more breast cancers than mammograms, digital breast tomosynthesis or ultrasound. MRI is not a replacement for mammograms, however, and should be used in addition to MRI exams.
“Understanding your breast density in addition to other risk factors is important,” Funaro said. “All Moffitt screening mammograms provide risk assessment scores to help women understand their risk, as well as being informed of their breast density.”
In early 2023, a study published in JAMA found too many women discount the density of their breasts when considering their risk of breast cancer. Of the women who participated in the study, 93% believed breast density was a lesser risk than others such as having a first-degree relative with breast cancer. The same study found that dense breast tissue is associated with a 1.2 to four times higher risk of breast cancer compared with a two times higher risk associated with having a first-degree relative with breast cancer.
While most women in the study correctly noted that breast density may make mammography more difficult to read, only 10% of women who were interviewed in the study understood that breast density contributes to breast cancer risk.
The new FDA changes require facilities to provide patients with information about their breast density and include specific language in the mammogram result letter to explain how breast density can influence the accuracy of a mammogram.
“Breast tissue can be either dense or not dense,” the FDA’s explanation reads. “Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. Your breast tissue is dense. In some people with dense tissue, other imaging tests in addition to a mammogram may help find cancers. Talk to your health care provider about breast density, risks for breast cancer and your individual situation.”
Patients at Moffitt already receive a similar message and will continue to receive them moving forward, according to Funaro.
“The goal of mammography, including women with a personal history of breast cancer, is to detect breast cancer early while it is still treatable and less likely to have undergone distant spread,” Funaro said. “Every patient that receives a mammogram at Moffitt, whether they are a former breast cancer patient or not, receives a letter notifying them of their results in plain language and follow-up recommendations.”
