Dr. Janie Lee
Any woman who has had a mammogram this year may have noticed that her results report looks a little different from previous years. Since Jan. 1, 2019, facilities such as Seattle Cancer Care Alliance that perform mammograms are required to inform women if they have dense breast tissue.
Women with dense breasts have more glandular and fibrous tissue, which makes it harder to detect tumors via mammography than in women who have more fatty tissue. Dense tissue looks whitish on a mammogram as do breast lumps, making it challenging to distinguish between the two. Women who find out they have dense breasts have lots of company; at SCCA, 54 percent of patients have heterogeneously (a mix of dense and less dense) or extremely dense breast tissue.
The new breast density notification law is designed to give women more context about their bodies. Every screened patient gets a letter explaining her results and breast density category, which can then be used as a springboard for a conversation with her doctor. (There are four categories of breast density ranging from fatty to extremely dense.) Women who have additional risk factors, such as having a strong family history of breast cancer or a genetic mutation that increases the risk of developing cancer, may be eligible for additional screening measures such as MRI.
“Density is important because it’s a risk factor for developing cancer and it also influences breast cancer detection,” says Dr. Janie Lee, director of breast imaging at SCCA. “But the number one message is that having increased breast density does not mean you’re automatically at high risk of developing breast cancer.”
To help women make sense of their density categories and what they mean, SCCA offers a Breast Health Clinic designed for women who don’t have cancer but are at higher risk of developing the disease. Community providers can refer interested women, including those with dense breasts, to the clinic, which is led by Dr. Sara Javid, a breast surgeon.
“I welcome them to come talk about their situation and what can be done to lower their risk and what can be done to monitor for breast cancer from an imaging standpoint,” says Dr. Javid. Some patients may also qualify for genetic counseling and/or testing for gene mutations that could predispose them to breast cancer.
Women who learn they have dense breasts shouldn’t be alarmed by the information, says Dr. Javid. “This is simply more information to gauge their risk of breast cancer, but it’s not nearly as strong an indication of developing breast cancer as a strong family history or a history of atypia on prior biopsy,” she says.
Mammography has been shown in randomized clinical trials to save lives. Even though density can make it harder to find cancer, mammography still finds a majority of cancers that are present. Mammography is most successful when women schedule an annual screening so radiologists can detect whether there have been changes from year to year.
“Screening mammography works when you use it,” says Dr. Lee. “We don’t want you to just have one mammogram. We want you to come back so we can find cancer when it’s asymptomatic.”
To make an appointment at the Breast Health Clinic, call (206) 606-6487 or (206) 606-7222. Find more information here.