Of course you would. We’re talking about your breast density number—and a growing number of proposed bills, new legislation, and advocates across the country are doing everything they can to make sure your doctor is required by law to tell you how dense your breasts are. Just like your blood pressure and your BMI, your breast density is a number you should know. Why breast density mattersA normal breast is composed of fat and glandular tissue, and what percentage you have of each is determined by genetics. You can’t feel it, and you can’t change it by what you eat or how much you weigh; only a radiologist can determine your density. “Your breast density is important when we’re talking about x-rays,” explains Monica Yepes, MD, director of Breast Imaging Services at the University of Miami School of Medicine’s Sylvester Comprehensive Cancer Center. On a mammogram, which is an x-ray of the breast, fat shows up as very dark, almost black, while glandular tissue is very white. “The difficulty is that cancer is also white on a mammogram—and when you have a dense breast, finding the white cancer amongst a white breast is like looking for a snowball in a snowstorm.” It’s a difficulty that affects between 40-50% of women, Dr. Yepes says. And as of today, there’s no real standardized way of measuring breast density, partly because it’s extremely subjective (what might look dense to one person reading the mammogram might not to another). Current standards ask radiologists to determine whether you fit into one of the four classifications that determine your score: 1-fatty replaced (mostly fat), 2-scattered fiber glandular (less than 50% glandular tissue), 3-heterogeneously dense (more than 50% glandular), or 4-extremely dense (very little fat). And where your breasts fall on that scale—usually a 3 or 4—might encourage you to pursue further testing via ultrasound or even MRI. But you have to know your score first. Where does your state stand?It all started when a woman in Connecticut was diagnosed with Stage 3c breast cancer in 2004, just two months after receiving a normal mammogram report from her doctor. Nancy Cappello, PhD, was told her breasts were dense, and her normal mammogram missed it in its early stages. After feeling a ridge in her right breast during a normal breast exam, her doctor sent her for an ultrasound which, before passing crucial legislation in her state, wasn’t the “standard of care” and therefore wasn’t recommended earlier. She has since beaten the odds, started the advocacy site AreYouDense.org, and pushed legislation through Connecticut that requires doctors to inform you of your density, as well as make you aware of additional screenings. And on January 21, New Jersey became the fourteenth state to pass a similar bill. (To find out where your state stands, check out the D.E.N.S.E. State Efforts Map.) Her doctor—like yours—was well aware of her breast density score (according to Dr. Yepes, the American College of Radiology and the Society of Breast Imaging suggests radiologists include some information about a patient’s breast density in the mammography reports that are sent directly to your doctor). However, that report is different than the letter you get from your doctor several weeks after your mammogram. And unless you live in one of the 14 states that have passed a notification law, that information probably isn’t making it to your mailbox. Ultrasounds: In addition to your mammogram, not instead ofDr. Yepes has known for years that mammograms are limited. “But in medicine, you’re trying to do evidence-based medicine,” she says, and 30 years of clinical trials have shown the benefits of mammograms. Your mammogram is still worth it, but new research shows a benefit of adding an additional ultrasound for those with dense breasts. “The research shows you’re going to catch 3-4 additional cancers per 1000 women with an added ultrasound,” which, according to Dr. Yepes, is the mark of a good screening program. It’s good news if you find extra cancers—“they’re usually small, about a centimeter or less, and not metastasized”—but it has resulted in adding what Dr. Yepes believes to be 20-25% more biopsies. “That means a lot more short term follow-ups, and a lot more anxiety for patients.” It also means a 3-4 month backlog for ultrasound appointments in Connecticut, which take between 15-40 minutes to complete. And unless you live in one of the four states that have passed an insurance bill regarding extra screening for dense breasts, you’ll have to pay more, too. Some women with dense breasts plus other breast cancer risk factors are recommended to receive MRI screenings—a $3,000 test. In Florida, where Dr. Yepes practices, there’s not an insurance bill, which means many insurance companies will not cover it. How to get your density report—every timeIf it’s not coming in your letter from your physician, ask. Some facilities will even allow you to request the mammography report yourself. Whether you receive an ultrasound in addition to your mammogram is still your personal choice. Doctors will take additional testing on a case-by-case basis until enough clinical studies prove otherwise. In the meantime, start adding your breast density score to your list of health stats you need to know so you can have an informed conversation with your doctor about your breast cancer screening options—especially if you score a 3 or more. Learn more about your options at AreYouDense.org.
