Mammograms may not be best cancer screener for women with dense breasts

Mammograms have become a tried and true test for breast cancer, but for some women there may be a better imaging option. (Courtesy photo)

PORTSMOUTH - A breast cancer surgical oncologist and medical director of Portsmouth Regional Hospital's Breast Center is alerting women who have what are known as "dense breasts" to ask their doctors about alternative imaging options beyond standard mammograms.

Dr. Lauren Thompson told The Rochester Voice on Friday that the crux of the alternative imaging argument centers on dense breasts, which are not only known to carry an increased risk of breast cancer but also make spotting tumors harder when using a mammogram.

Thompson says the reason is simple.

A woman's breast is made up of glandular lobules that make milk, and ducts that take it to the nipple, she said.

Dr. Lauren Thompson

"On a mammogram fatty tissue is black and glandular looks white. The trouble comes if you have a tumor, which is also white," Thompson noted. So when a woman has dense breasts the ratio of glandular to fatty tissue is very high. The glandular looks white, and the tumor looks white.

She said doctors refer to it as like "looking for a snowball in a snowstorm."

The issue has recently come to the fore after the FDA proposed changes that would require women with dense breasts to be warned that alternative imaging like ultrasound or MRI should be considered,

The FDA proposed the changes late last month, and the process is now in a public comment stage that lasts till late June.

Currently, Thompson said, women who have dense breasts and test negative for breast cancer are told to come back for another mammogram in a year.

If the FDA new guidelines are adopted mammography providers would have to inform patients who undergo the breast cancer screening test if they have dense breast tissue.

Thompson said women would also be told of different imaging options that might be more effective for them, like an ultrasound or MRI.

Where insurance companies would come down on this added expense is unclear, Thompson warned.

"They may or may not be on board with paying for it," she said. "It'll be up to the patient, the doctor and the insurance provider."

Any change of guidelines won't force insurance companies to cover the extra cost, she said, but the primary care provider would also be notified.

Thompson said there's no way for a woman to tell if she has dense breasts without an x-ray, and the condition is equally prevalent among busty and small-chested women.

As the No. 1 cancer threat to women, Thompson is hoping insurance companies will side with "women, safety and science."

"This is a really important development," she added. "It's great the FDA is empowering women in their health."

Thompson said women should start getting examined for their risk of breast cancer at age 40 and continue monitoring their breast health through menopause and, for seniors, as long as they remain in good health.

If anyone wants to comment on the new FDR proposals they should go to Regulations.gov.