Nearly half of women in the United States have a high breast density, and if you are one of them, South Florida doctors urge you to think differently about breast cancer screenings.
Breast cancer survivor Cassandra Caldwell says doing so saved her life.
Caldwell, 52, who lives in Fort Lauderdale, said she had no symptoms and her initial mammogram did not detect any cancer. A supplemental ultrasound, however, revealed a tumor that turned out to be stage 2 triple-negative breast cancer, an aggressive form of cancer known to have a faster growth rate and higher risk of metastasis and recurrence.
With dense breast tissue, a regular mammogram may not be enough because undetected breast cancer tumors can be concealed, doctors say. On a mammogram, dense tissue looks white, and so does cancer..
“When a patient has dense breasts, I generally augment mammograms with an ultrasound,” said Dr. Alia Abdulla, a breast surgical oncologist with Broward Health Physician Group.
Abdulla said from an initial mammogram, a radiologist will include the level of density of your breast tissue. If your mammogram report says that you have dense breast tissue, talk to your healthcare provider about additional screening tests available, she said.
While most insurers routinely fully cover annual mammograms as preventive care, they often require the patient to shell out a co-pay or pay out-of-pocket towards a deductible for the ultrasound.
Caldwell says her cancer could have been left undetected for a long period of time without the ultrasound screening. She has since undergone chemotherapy, a lumpectomy, radiation, and she takes daily medication. Although she is cancer-free after a 14-month journey to remission, she continues to be screened with quarterly blood tests and regular mammograms, ultrasounds, and a doctor’s breast exam.
Ultrasounds are the most common for supplemental screenings, but other tools also are being used
The Lynn Cancer Institute at Boca Raton Regional Hospital is participating in a national clinical trial for contrast-enhanced mammography as a preventive screening tool for women with dense breasts. The screening combines mammography and IV contrast to examine blood flow and help identify lesions in breast tissue
Contrast-enhanced mammography could be better at detecting cancers in women with dense breasts than the mammogram/ultrasound combination, but it hasn’t studied until now, says Dr. Louise E. Morrell, medical oncologist and the medical director of Eugene M. & Christine E. Lynn Cancer Institute. Morrell said anyone with dense breasts who wants to participate in the three-year study can enroll. This type of screening carries a small risk of adverse reactions to contrast materials.
Dr. Elizabeth Dibble, a breast cancer imaging specialist, said breast density is categorized into four groups by radiologists — from fatty to extremely dense.
“When your doctor gets your mammogram report, you will actually have one of these categories in your report,” she said during a WebMD webinar on breast density Thursday.
Dibble, an associate professor of diagnostic imaging at the Warren Alpert Medical School of Brown University, said some studies have shown dense breasts are linked to an increased risk of breast cancer and to patients who present with larger and more aggressive tumors at the time of diagnosis. There also is a link between density and with cancer already present in nearby lymph nodes at the time of diagnosis, she said.
Because of the limitations of mammograms in women with dense breasts, 38 states (Florida included) now require some level of breast density notification. They also require imaging providers to inform women of the possible benefit of added types of screenings. Nationally, a federal bill has been proposed that calls for requiring insurers to fully cover additional screenings for individuals at greater risk for breast cancer.
Most imaging centers now use 3D mammography, which has a better detection rate for cancers in dense breasts than the previous 2D mammography. However, Dibble said, “A big limitation is that it’s still hard to detect breast cancer in dense breasts, even on a 3D mammogram. So it really doesn’t obviate the need for a patient potentially undergoing some additional supplemental screening.”
Some studies are looking at MRIs as a supplemental screening tool. Dibble says they could be an additional tool, but not a replacement for mammography. “MRI does not detect every single breast cancer that a mammogram does. Sometimes we can see an abnormality with an MRI, but not always,” she said.
Women experience changes in their breast density as they get older. They tend to become less dense, but not enough to rule out additional screenings, Dibble said.
There are ongoing clinical trials related to dense breasts that are studying better ways to detect breast cancer. Contact NCI’s Cancer Information Service to get information.
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.