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What referring physicians need to know about breast density

Posted on: 01.10.17

It’s increasingly understood that dense breast tissue is an area of concern for women’s health. Not only is a woman’s risk of developing breast cancer greater with the highest density, it also can mask small masses along with increasing medical evidence that woman with higher breast density have a higher cancer reoccurrence rate.

To date, 29 states have passed laws that require patients with dense breast tissue to be notified through some level of formal communication. Unfortunately, however, the rules and regulations vary greatly across each state. This has created uncertainty and confusion both for the patients and medical providers.

Notification Best Practices

Recommendations and suggested next steps for those identified as having dense breast tissue vary from provider to provider. Some facilities will review the results of a mammogram in person with the patient, discuss the density, and offer recommendations about next steps. More often, however, facilities comply with the minimum requirements, which may include mailing a letter to the patient, but does not require the inclusion of an explanation of breast density, the concerns that accompany it, or what other actions might be recommended. While this approach meets the requirement of the law, it often leaves patients alarmed and confused by the news with no context or professional advice.

Regardless of whether you reside in one of the 29 states, the need to address breast density and the concerns that come with it is indisputable. Because of the increased risk it brings, educating patients and recommending additional screening options as part of their care plan is every physician’s responsibility as a trusted authority. It’s incumbent upon them to step up and not only notify patients about their dense breast tissue, but to explain what it means to them and what they should do about it.

Moving from Ultrasound to MBI

All providers agree that screening methods should be as quick, accurate and cost-effective as possible. Typically, following mammography, ultrasound fits the bill and traditionally has been the most popular follow-up screening method for patients with dense breast tissue. However, ultrasound is a study that looks at the structural aspect of the breast density and may not be able to accurately see beyond the fibrous tissue leaving some valid concern about any hidden cancerous cells.

Another modality, molecular breast imaging (MBI), is gaining more attention in the medical community. The physiologic image produced by MBI is an alternative view that could increase clinical confidence and ease concerns. With MBI, the injected radioactive tracer highlights areas of concern making cancerous cells easier to detect within or behind the fibrous tissue.

Of course, there are other factors that need to be considered, such as family history, personal medical history, radiation exposure and even financial issues because of the increased cost, but MBI may be a viable screening option for some patients. In the absence of well-established appropriate use criteria, physicians are left to determine which options are best for their patients and should take advantage of all that is available to them.

Education is key

As a medical professional or physician, it’s important to further educate yourself on breast density, the heightened concerns, the improved technology within the industry, and how you can best educate your patients. Patients are looking to you for guidance, and the ultimate level of service you can provide is your best, most confident recommendation for next steps.

Screening options and recommendations for dense breasts

Posted on: 10.20.16

The topic of breast density is gaining attention lately. To date, 29 states have mandated some level of formal communication to inform women not only of their mammogram results, but also their breast density level. In the battle against breast cancer, there is a growing need and demand for patients to be educated about breast density and their potential need for additional imaging.

What is breast density?

Upon completion of your last mammogram, you may have received a letter informing you that you have dense breasts, and you may be wondering – what does this mean? Breasts are made up of fibrous or glandular tissue and are considered dense when the percentage of fatty tissue is low.

Although women with dense breasts may require additional screening, it is not abnormal. The additional concern is merited because studies have shown that dense breast tissue increases a woman’s risk of developing cancer, and may have some bearing on its reoccurrence. Also, because both dense breast tissue and cancerous cells appear white on a mammogram image, the greater the opportunity is for abnormalities to hide behind the dense tissue and go undetected.

What should I do?

If you’ve had a mammogram and been told that you have dense breasts, your doctor may order additional imaging, typically a screening ultrasound. If the result is inconclusive or your risk level warrants it, he or she may order a molecular breast image (MBI).

An ultrasound uses high-frequency sound waves to create an anatomical view of the breast tissue, which shows exactly how the tissue looks. With the help of a thin layer of gel, a transducer is moved across the breast creating the image, which is based on the reflection of the waves against the body. Ultrasound can be performed with or without the assistance of a dedicated radiologist, depending on the method, and there is no ionizing radiation exposure associated with ultrasound imaging. It’s also relatively inexpensive, by comparison, and the procedure takes approximately 15 minutes plus interpretation time.

MBI uses a radioactive tracer to detect cancer inside the breast. Once the tracer is injected, a nuclear camera takes a physiological image, which captures the interaction of tissue surrounding a cancer as opposed to a snapshot of how it looks. Any abnormal cells will attract a higher concentration of the radioactive substance and identify areas of concern. The MBI procedure typically takes approximately 40 minutes plus interpretation time, and is more expensive than an ultrasound. However, unlike the anatomic images produced by mammography or ultrasound, the physiologic imaging of MBI may offer more conclusive diagnostic confidence.

Take action!

Hearing that you have dense breast tissue may be upsetting, but don’t sit back and accept the uncertainty that comes with it. Take action. By communicating with your physician and discussing your individual need for additional testing, you’ll be doing everything possible to ease your mind. Screening for disease is the key to early detection and being an educated, responsible patient who takes your health seriously will help you live a long and healthy life.

Understanding the differences between Ultrasound or MBI for Breast Imaging

Posted on: 09.22.16

If you were told after your last mammogram that you have dense breast tissue, your doctor may have recommended additional imaging. One of the details included in the mammography report from the radiologist to your doctor is information on how “dense” your breasts are.

Breast density is assigned one of four categories:

  • A – the breasts are mostly fatty
  • B – there are scattered areas of fibroglandular density
  • C – the breasts are heterogeneously dense which may obscure small masses
  • D – the breasts are extremely dense which lowers the sensitivity of mammography

Breast density may increase your risk of developing breast cancer and it can hide small masses making it difficult to diagnose. Often times, breasts that are classified as heterogeneously dense or extremely dense may benefit from additional imaging. Physicians typically opt for an ultrasound or molecular breast imaging to gain a better view and increase their clinical confidence.

Ultrasound vs. MBI

One of the main differences between breast ultrasound and molecular breast imaging is the type of image each produces, either anatomic or physiologic, respectively.

An ultrasound uses high-frequency sound waves to produce an image of the anatomy of the breast tissue at that exact location. With the use of a transducer and a thin layer of gel, the procedure creates a picture that shows the radiologist how the sound waves travel through the density and what the breast tissue looks like.

A molecular breast image produces a physiological image, which demonstrates the interaction of tissue surrounding a breast cancer or any other area of interest in the breast. It shows how the body is performing or reacting. With the help of a radiotracer, the molecular image shows how much of the isotope the tissue is absorbing. Cancerous cells will attract a greater concentration than normal healthy cells, indicating an area of concern.

If you compare these images to a weather map, the anatomical view would be the topographic map where you can see the depth of a mountain range from above, while the physiological picture would be more in line with Doppler radar, where you can see the clouds approaching and the effect they have on the covered area.

Which test is best?

When you consult with your physician, he or she will take into account your individual medical and family history, risk factors, and other health issues before making a recommendation for additional testing.

The ultimate purpose of screening is early detection, but it’s also important for tests to be as quick, accurate, and inexpensive as possible. Mammography is the least expensive method of screening, followed by ultrasound, and then MBI. If your ultrasound results are inconclusive, MBI would most likely be the next step.

MBI has 10+ years of history in the breast imaging world, but it is still considered new technology, which is one reason why appropriate use criteria for the modality is still in the developing stages. Educating yourself and communicating openly with your doctor will help accurately weigh your risk factors and address any concerns so that they can recommend a suitable screening option that meets your specific needs.

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