What referring physicians need to know about breast density

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.


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