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Supplemental Screening for Women with Dense Breast Tissue
Women with dense breast tissue have a higher risk of breast cancer than women with fatty breast tissue. Breast tissue density is common. By the age of 40, about 40 percent of women will have developed dense breasts. Breast density is frequent in younger women because their breasts are denser prior to menopause. After menopause, women’s breasts develop more fat and less density. Breast density heightens breast cancer risk due to decreased mammographic sensitivity. In medical terms, this refers to the relative quantities of fat (radiolucent) versus epithelium and stroma (radio dense) in breast tissue.
Supplemental Screening
The thickness of dense breast tissue decreases the efficacy of the mammogram increasing the risk for developing breast cancer. Women with dense breast tissue may require supplemental breast cancer screening, an effort to augment the degree of cancer discovery. The quicker cancer is discovered, the chances are it may be smaller and respond to treatment in a more favorable manner. Early detection can possibly lessen the risk and need for chemotherapy or a mastectomy.
Focusing on supplemental magnetic resonance imaging (MRI) for women with extremely dense breast tissue along with normal mammography can result in fewer diagnosed interval cancers than mammography alone. Studies have shown supplemental screening sonography after mammography can benefit the patient.
Investigated Screening Breast Ultrasound
Common screening mammography continues to be the most valuable instrument in breast cancer detection. Mammography has dependably helped in reducing loss of life from breast cancer. However, mammography will not discover all forms of breast cancer. Females with heterogeneously thick breast tissue may benefit from digital mammography over traditional film mammography when it comes to breast cancer screening. Studies have found in women with dense breasts, digital mammography excels over traditional film mammography in finding breast cancer.
An optimum supplementary examination or screening concept being applied to women with breast density includes ultrasound or contrast-enhanced mammography (digital breast tomosynthesis is an advanced form or 3D mammography of breast tissue using X-rays. Digital tomosynthesis differs from a typical mammogram in the method a CT chest scan is dissimilar from a standard chest X-ray. Another way to think of this concept is with geometry, digital tomosynthesis is 3D while a standard X-ray is flat. During a traditional mammogram, the breast is compressed between two glass plates and images, taken from top and bottom and side to side are recorded onto film. A radiologist reading the film is looking for breast cancer, which appears to be thicker than healthier breast tissue and can appear as irregular white areas or shadows. Compression of the breast throughout the mammogram process can present in an uncomfortable manner and discourage some women from getting the test in the first place.
Compression of the breast can also cause the breast tissue to overlap in turn hiding the breast cancer causing it not to show up on the mammogram. The limitation of a traditional mammogram is the fact pictures of the entire breast are only taken in two aforementioned directions: side to side and top to bottom. This can be like walking to edge of the ocean and looking for a particular shell in a vast amount of water. Radiologists are dedicated and hard-working, it’s not easy. But, what if to find the shell, an individual took a dozen or so steps at a time into the water and ventured in all directions of the immediate surroundings to find the shell? Digital tomosynthesis uses this concept to take multiple X-ray images downloaded into a computer software program to capture images of breast tissue from all angles. Breast positioning focuses on very little compression so only a minute amount of pressure applied and really only to keep the breast in place during the procedure. As many as 11 images can be taken during a seven-second examination, sent to a computer to be published as a well-defined, in-focus 3D image of the breast tissue and entire breast.
According to a recent U.S. National Library of Medicine, National Institutes of Health medical article, investigated screening breast ultrasound in women with dense breast tissue and at least one additional breast cancer risk factor, has resulted in an incremental detection rate when breast cancer screening ultrasound was added to mammography. To date, MRI has the highest incremental cancer detection rate, especially in reporting in the high-risk population following a negative mammogram. Additionally, findings have shown ultrasound considerably heightens discovery of minute as well as largely invasive or aggressive node-negative cancers.
In the medical journal paper, The Role of Ultrasound in Screening Dense Breasts—A Review of the Literature and Practical Solutions for Implementation, the benefit or advantage of MRI detected cancers should be balanced with false positive rates which occur at time of baseline MRI and subsequent MRI screening. In addition, breast MRI needs intravenous gadolinium contrast, which can make it a more expensive test.
Augmented breast tissue density includes a possibility of hiding breast cancer which can lead to a delayed diagnosis. Additional or supplemental imaging is optional and recommended for specific individuals in the patient population. According to a recent American Cancer Society report, there is insufficient evidence to recommend for or against MRI in women with heterogeneously or extremely dense breasts on mammography as their only risk factor. In Europe, the Dutch Dense Trial investigated this concept. Women with dense breast tissue should communicate with their doctor about breast cancer risk assessment. The dialogue between women with women with dense breasts should also include breast cancer prevention strategies, potential for false negatives, additional biopsies and increased cost for more in-depth screening tools. According to the U.S. Preventive Services Task Force, risk models can help guide individual screening recommendations but even in the absence of family history, breast density may justify supplemental screening and insurance reimbursement is variable.
Dr. Rodrigo Arrangoiz is a board-certified surgical oncologist specializing in head, neck and breast surgery. His areas of interest include breast cancer, thyroid, parathyroid and adrenal cancers, skin cancer and benign tumors. Dr. Arrangoiz’s office with the Center for Advanced Surgical Oncology is located at 7150 W. 20th Ave., Suite 615, Hialeah, FL 33016. In addition, Dr. Arrangoiz is on-staff at both Palmetto General Hospital and Coral Gables Hospital. Dr. Arrangoiz is fluent in both English and Spanish
