Hello bOObs Bloggettes:
I’m going to repost this blog as an overview to dense breasts and the problems that ensues with screening:
The dense breast tissue issue (DBT) is HUGE for breast cancer (BC) screening. Why? Because 90% of us have some degree of DBT.
Density levels are determined by what a radiologist sees on your mammogram’s X-ray. Degrees of density are broken down like this, in ascending order of density: 10% of us have “fatty” breasts, which are almost all fat (but I have yet to meet one woman who falls into this category); 40% have “scattered” density, which is considered “low” density by radiologists reading your mammography report; 40% have “heterogeneous” density, which is getting much higher; and an unlucky 10% are in the upper category of “extremely” dense tissue. For the latter, the mammogram misses up to about 50% of BC — and for this reason the mammogram is not very helpful for these women. For the lucky 10% of women who have all fatty tissue (again, whoever they are!), the mammogram works pretty darn well at finding BC, AND they don’t have to increase the radiation load in order to find BC.
But realize this (which I didn’t until I undertook this project): The higher the degree of dense tissue in your breasts, the more they have to crank up the mammogram’s radiation to see through the tissue. And it can reach pretty high levels pretty darn quickly. Why do they do this? Because dense breast tissue appears white on a mammogram — and so does the cancer. And increasing the radiation apparently helps differentiate the two.
Who knew, right? I was never told this. All I’ve heard at the time of screening has been: “Oh, you have dense breasts.” And I thought “Look, I don’t care if my breasts are made out of Play-Doh as long as I don’t have cancer. Can I get out of this god-awful ugly gown and get the heck out of here please? My dense breasts are freezing!!!”
This brings me to my next point: Women in the higher density categories of “heterogeneous” and “extremely” should absolutely consult with their doctors and plead (if necessary) for an ultrasound in addition to the mammogram. I know several women with DBT who, sadly, only had mammograms only to find out later found that an ultrasound would’ve caught their BC earlier. (In fact, I’d ask for an ultrasound if I were in the lower “scattered” category too, because any DBT at all can mask a cancer.)
Many of you have asked if you could get an ultrasound if you have dense breasts and skip the mammogram to avoid radiation, and the YEE-OOOWWW! of being squished like a pancake. Alas, the answer is “no”. Insurance, for the most part, will not cover an ultrasound unless you have a mammogram first. It’s medicine’s Standard of Care and the way the insurance reimbursement schedule is laid out (see my other post on this topic).
To expand on that, I wanted to explain insurance and the Standard of Care a wee bit: Mammography is the only BC screening tool that has been deemed a “primary screening test” by the US FDA and probably had something to do with Medicare coverage originally (all roads lead to Medicare coverage, which I’ll blog about at another time). All the other screening devices — ultrasound, MRI, thermography — are called “adjunctive tests” to mammography. Thus, insurance won’t pay for an adjunctive test unless the primary test of mammography is performed first. And in the case of thermography, even then it won’t be covered … but that’s another blog for another time.
Also know this: Women with DBT have 3 to 6 times increased chance of contracting cancer in their lifetime — and the denser your breasts, the more likely it is. You won’t believe what I uncovered in the medical literature on this topic, so this will be covered more in upcoming blogs.
You’ll be hearing a lot from bOObs blogs on DBT, but a good source for dense breast tissue information can be found on my dear friend Joe Cappello’s website for “Are You Dense”, an organization founded by his late wife Nancy; Joe is interviewed in my film where he tells the horrific story of mammography missing his wife’s cancer repeatedly in her extremely dense breasts for over a decade: https://www.areyoudense.org
For any of the issues in my blogs, FYI, you can find medical literature citations in my film (see link below) so you can do further research.
Blog at you soon, thanks for reading and helping to spread the word! (Please see the “share” links below.) And we’d love to hear comments from you! (see below as well)
Stay healthy,
Megan
Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts
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