Women soon may strive to know their breast density


Published: Wednesday, October 24, 2012 at 8:59 p.m.
Last Modified: Wednesday, October 24, 2012 at 8:59 p.m.

Knowing if you have dense breasts -- considered a risk factor for breast cancer -- may soon be as commonplace as knowing whether you have high blood pressure or a high blood sugar level. But figuring out what to do with that information remains a challenge.

After California became the fifth state last month to pass a law obliging physicians to tell women whether or not they have dense breasts, local physicians are examining their own clinical practice.

"I would be perfectly happy [telling women] even before it's legislated," said Dr. Julia Marshall, a radiologist and the head of the mammography division at the University of Florida & Shands Breast Center. "But we need to iron out some details so we don't end up with a ton of women panicking because they may need other tests."

And many of those women may be young and fit -- exactly the type of women in whom you wouldn't expect to find a lot of breast cancer, Marshall explained -- even though it's precisely these women who often have dense breasts.

"It's not surprising to find dense breasts in a woman under the age of 40," said Dr. Martin Holzman, a radiation oncologist at the Community Cancer Center of North Florida. "If you're still menstruating, you can get pregnant and lactate. Your ducts are filled with milk so that's what makes the breasts dense."

Fit women are also more likely to have dense breasts because they have less fatty tissue throughout their body, including the breasts. What makes breast dense is a higher level of fibrous connective tissue.

"Certainly, you don't want to gain weight," said Marshall, since higher body fat is actually another risk factor for breast cancer. "So I tell patients, 'It's harder to look at your mammograms, but otherwise you're doing the right thing.'"

It is estimated that about 40 percent of screened women in the U.S. have dense breasts. Part of the risk for breast cancer lies in the fact that the dense tissue may mask underlying tumors.

There are four categories of density, and a woman's density level is recorded in her medical report shared with her doctor. Now patients also will receive this information in Connecticut, Texas, Virginia, New York and California.

Part of the problem in making patients privy to this information is that measuring density is subjective, said Marshall. "Is our subjective assessment accurate enough to tell patients and have them make health decisions?"

Marshall is considering acquiring new computerized software designed to make gauging density more objective.

Another bigger problem, though, is the potential cost associated with further testing -- such as MRIs and ultrasounds. About 40 percent of women who undergo mammography are found to have dense breasts, so if many of those start requiring more tests, "Suddenly the cost of detecting a breast cancer becomes quite high," said Marshall.

"It's expensive. You have to pick your players," Holzman said. "I wouldn't start asymptomatic patients that are not at high risk with MRI or ultrasound."

Mammography is still the gold standard for detecting breast abnormalities, Holzman continued, careful to distinguish mammographic density from density that a woman might feel when doing a self-check. If a woman does feel a lump that a mammogram doesn't pick up, however, Holzman would recommend an ultrasound or an MRI.

"We're moving into the era of transparency where people should be informed of everything," said Holzman.

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