As of September 10th, the Food and Drug Administration is requiring notification of all mammography patients that they do or do not have dense breast tissue, which is the patient-specific breast composition of dense fibroglandular tissue in proportion to fat tissue.  The reasoning for this is to appropriately educate patients with dense breast tissue that they may have (1) a breast cancer masked / hidden by the dense white breast tissue on the mammogram, and (2) a higher risk for developing breast cancer because of the prominent glandular tissue composition. Sadly, despite extensive awareness efforts, a recent Myriad Genetics study reveals that 44% of women still do not understand breast density, and 63% are unaware of its connection to breast cancer. Ongoing patient education is essential, so, What do I do if I have dense breast tissue? 

Look at your breast cancer risk through family history, previous biopsies and possibly indicated genetic testing: 

By combining genetic insights, family history and other clinical factors like breast density, MyRisk® Hereditary Cancer Test with RiskScore® calculates a woman’s 5-year and remaining lifetime risk of breast cancer. If a woman is found to be at high risk, she then has multiple options available to her, including a change in medical management, and additional supplemental screening imaging.  Our Boutique Breast Imaging center routinely assesses this Myriad MyRisk and provides a breast density-specific score to all patients under 70 years old. 

A. If high risk for breast cancer (greater than 20% Lifetime Risk for breast cancer or >1.7% 5-year risk for breast cancer), then supplemental imaging with contrast-enhanced breast MRI is recommended every year, staggered 6 months from the mammogram.  Certainly, a known genetic mutation such as BRCA1 or BRCA2 would warrant an annual mammogram and breast MRI, as well as clinical evaluation twice a year with consideration for prophylactic measures (anti-estrogen treatments or even surgery).   

B. If a patient has an intermediate risk for breast cancer (15-20% calculated Lifetime Risk for breast cancer), then the patient should consider additional Abbreviated Breast MRI imaging, particularly as a baseline, and / or Whole Breast Screening Ultrasound (more comprehensive if performed as a Handheld breast ultrasound by an experienced technologist/breast radiologist, versus an Automated Breast Ultrasound (ABUS), which may warrant repeat diagnostic ultrasound for questionable machine-detected abnormalities).  All of these additional studies for patients not meeting “high risk > 20% lifetime risk” criteria are currently not routinely covered by insurance in the state of Florida and are offered at cash pay prices.   

C. If a patient has an average risk for breast cancer (<15%), then additional supplemental imaging should be considered in patients with Extremely Dense breast tissue (10% of all patients) with either an Abbreviated Breast MRI or Whole Breast Screening Ultrasound.  Additionally, in cases of Heterogeneously Dense breast tissue, those patients with higher anxiety levels or hormonal stimulation (i.e. peri-menopausal hormone surges or exogenous post-menopausal hormone replacement therapy) may consider additional imaging with Abbreviated Breast MRI or Ultrasound. 

In conclusion, “Additional testing for women with dense breasts is medically necessary and the U.S. needs to catch up to other high-income countries that cover it. As a nation, we can do so much better…” Teri Thomas, Volpara Health CEO, was recently quoted in a USA Today article titled, New mammogram guidelines from FDA shift what patients should know. This was in response to Volpara Health, American Cancer Society, American College of Surgeons, and many others that support the Find It Early Act, a bill introduced in Congress in May 2023 that would guarantee full insurance coverage for women with dense breast tissue to get supplemental screening. For further information on Dense Breasts, see DenseBreast-info.org (www.densebreast-info.org). 

Visit Boutique Breast Imaging at 6871 Belfort Oaks Place, Jacksonville, FL, 32216, to receive personalized breast cancer screening recommendations.  Scheduling at (904) 901-0110 or scheduling@BoutiqueBreastImaging.org. 

*Abbreviated Breast MRIs detect approximately 10 cancers / 1000 patients INITIALLY screened with approximately 107/1000 false positives, requiring additional imaging or biopsy.  The sensitivity for additional cancers found on follow-up decreases with MRI to 3/1000 patients (with only 33/1000 false positives), so Ultrasound screening, which detects approximately 1-3 cancers / 1000 patients screened with 45/1000 false positives might be an alternative supplemental screening modality in intervening years, the ultrasound performed at the same time as the annual mammogram screening. (https://densebreast-info.org/wp-content/uploads/2024/08/Cancer-Detection-by-Screening-Method-in-Dense-Breasts081924.pdf)