The Latest on Breast Cancer Screenings

By: Laura Lipold, MD • Posted on October 16, 2024

Effective September 10, 2024, there is a new FDA national requirement that all mammography facilities include one of two breast density statements on the screening mammogram report - "no density or density."

This is in addition to whether or not they see any abnormal findings on the mammogram like a concern for breast cancer.

This is an example of what the mammogram reports may look like:

No density:

“Breast tissue can be either dense or not dense. 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 not dense. Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation.”

Density:

“Breast tissue can be either dense or not dense. 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 healthcare provider about breast density, risks for breast cancer, and your individual situation.”

The healthcare clinician who ordered your mammogram will also receive a report and this will provide more description of the breast density, if present (for example heterogeneous or extreme).

What is breast density?

Breast density determination is via breast imaging, for example, a mammogram which is basically an x-ray of the breast tissue. It is not based on breast size or physical examination findings.
Breasts are composed of two types of tissues: fibroglandular and fat. Dense breasts have a certain amount of fibroglandular tissue relative to fat tissue. The more fibroglandular tissue there is compared to fat tissue, the denser the breasts are.
About 50% of all individuals who have a mammogram are identified as having dense breasts, so this is a common finding.
Be aware that breast density can change over time, so be sure to read each mammogram report that you receive carefully to see if you do or do not have breast density.

Why does breast density matter?

Extreme breast density increases the risk of breast cancer.
Fibroglandular tissue appears whiter on the mammogram X-ray compared to fatty tissue. Because denser breasts have more white areas, it can make it harder to see small early cancers (which also can appear white).

What is the best breast cancer screening test if I have breast density?

Digital mammogram remains a mainstay of breast cancer screening even in those who have breast density.
Tomosynthesis digital mammogram ("3D mammogram") has recently been demonstrated in studies to perform a little better than 2D mammogram in terms of picking up breast cancers at an earlier stage and may reduce the chance of call backs in those who have dense breasts.
Not all facilities have the capability for 3D mammograms, so getting a 2D mammogram is still a very good test compared to no screening at all.

Supplemental screening in addition to mammography has been shown to pick up some cancers potentially missed on mammography in women with breast density. Examples of these supplemental screening tests include whole breast ultrasound and breast MRI. The potential drawback of having these tests could be more false positives (and unnecessary biopsies) and potential costs not covered by insurance. And these tests are not meant to replace a mammogram; they are in addition "supplemental" to the screening mammogram.

It is very important to have a conversation with your healthcare clinician to help you assess your overall breast cancer risk. Breast density is one of multiple risk factors and there are clinical tools available that can estimate your lifetime breast cancer risk. Understanding breast cancer risk and breast density can help to guide you and your healthcare clinician on future decisions on optimizing your breast cancer screening strategy and taking potential measures to reduce breast cancer risk.

Remember to always stay in tune with your body and immediately report any breast changes to your healthcare clinician!

Be Strong, Be Healthy, Be in Charge!
Laura Lipold, MD

Laura D. Lipold, MD is on Staff in the Department of Family Medicine at Cleveland Clinic and Director of Primary Care Women's Health. She has academic faculty appointments at Case Western Reserve University and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Lipold is board-certified in family medicine.

mammogram, breast cancer screening, screening mammography, breast cancer, dense breasts, breast density, women's health, dr. laura lipold, screening mammogram

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