Weekly Newsletter

The best of The Saturday Evening Post in your inbox!

Join SUPPORT THE POST

On September 10, 2024, a new U.S. Food and Drug Administration policy went into effect requiring all screening mammogram facilities to notify patients about their breast density. What does this mean, and how will this affect your breast health?

Depending on where you live, this new federal standard might not change much at all. Breast density notifications were already the law of the land in 39 out of 50 states, plus the District of Columbia. The new federal standards could change the wording and/or timing of breast density notifications, but the substance will remain the same.

In Alaska, Arkansas, Idaho, Kansas, Maine, Mississippi, Montana, New Hampshire, North Dakota, West Virginia, and Wyoming, mammogram centers are newly required to notify all patients with dense breasts. Roughly half of all women have dense breasts and will therefore receive a notice with their next mammogram.

Subscribe and get unlimited access to our online magazine archive.

Subscribe Today

What's the big deal about dense breasts? What does having dense breasts mean, and why does it matter? Let's talk about it.

Screening mammograms are one of the most common cancer screening exams worldwide, and one of the preventive health services that must be covered for free under U.S. law. As of 2021, 75.9 percent of American women age 50-74 were up to date on screening mammograms.

Breast screening saves lives. Improvements in early detection and treatment have contributed to a 42 percent decline in U.S. breast cancer deaths between 1989 and 2021. One of the well-known limitations of mammograms is that they are less sensitive in women with dense breasts. Breast density is a measure of how much glandular and connective tissue is present, as opposed to fatty tissue. Compared to women with fatty breasts, women with dense or extremely dense breasts face both an elevated risk of breast cancer and decreased sensitivity of mammograms. Despite this, dense breasts do not increase the risk of death from breast cancer. This may be due to the fact that breast density correlates with younger age and physical fitness. Thus, women with dense breasts are both more likely to get breast cancer, and more likely to survive breast cancer.

So, let's say you get a notification saying that you have dense breasts. What should you do? Most of the time the answer is "nothing special." Neither the U.S. Preventive Services Task Force (USPSTF) nor the National Comprehensive Cancer Network (NCCN) recommends any special screening test for the majority of women with dense breasts. While many supplemental tests exist such as ultrasound, MRI, contrast-enhanced mammography, or molecular breast imaging, any additional testing could risk false-positive scans and unnecessary breast biopsies. These could add cost, inconvenience, pain, and risk of complications. And since the vast majority of women with dense breasts don't have a high risk of death from breast cancer, the absolute benefit of supplemental screening may not be great enough to outweigh the risks.

That said, the balance of risks and benefits is highly dependent on your underlying cancer risk. If you both have dense breasts and other breast cancer risk factors, such as family history, prolonged estrogen/progesterone use, prior breast lesions, or prior radiation exposure, it may make sense to add MRI or other imaging studies to your annual mammograms.

This is a personal decision that should be made in concert with your primary care provider and/or breast screening center. You may be asked to fill out a questionnaire to better calculate your breast cancer risk.

Whether or not you have dense breasts, if you are a woman between the ages of 40 and 74, you should make sure that you're up to date on screening mammograms.

Become a Saturday Evening Post member and enjoy unlimited access. Subscribe now