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Mammograms may have trouble seeing cancer in 50% of women

The FDA confirms they are in the process of amending existing mammography regulations to include mandatory notifications and specific topics for women.
Updated: Apr. 3, 2022 at 9:00 PM MST
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PHOENIX (3TV/CBS 5) -- Sitting on her sofa watching television, Kathy Parker felt a soreness across her chest. The active grandmother wasn’t immediately alarmed, attributing the discomfort to overexertion during physical therapy for an issue with her shoulder.

As she massaged her muscles, she felt something unusual, prompting her to lay down to do a self-exam. As her breasts shifted, a tumor shielded behind a milk duct was exposed, and the lump was so pronounced that it could be seen under her skin.

Panic overtook Kathy. It was the moment she knew she had breast cancer. What didn’t make sense; Kathy’s mammogram the year before came back with “normal” results.

No doctor had ever discussed with Kathy that she had dense breasts, informed her that dense breasts could prevent mammograms from seeing cancer, or told her dense breasts increase cancer risk.

About half of all women have dense breasts. Fatty breast tissue shows up black in a mammogram making cancer, which shows up white, easier to spot. Women with dense breasts have more fibrous tissue. Like cancer, fibrous tissue shows up white, making tumors challenging to see.

Only a mammogram can determine if a woman has dense breasts. Even with the tumor visible in the form of a lump, a follow-up mammogram still did not show Kathy’s cancer. An MRI revealed two large tumors in her left breast. One measured 5.5 centimeters (2.1 inches), and the second measured 3 centimeters (1.1 inches). Kathy says an oncologist told her an MRI likely would have picked up the cancer when the mammogram missed it a year earlier.

In studying her condition, Kathy made a discovery. Tests results over the years showed she had dense breasts, but no doctor informed her about the option of additional tests.

Reading the mammogram test results, Kathy is angry over the wording in the results: “We are pleased to inform you that the results of your breast imaging performed on January 27, 2021, are normal.”

In the first sentence of her results, Kathy said the word normal led her to believe she did not have cancer or reason to be concerned. That phrasing is a source of anger and frustration. “If it causes cancer, that’s not normal. Stop calling it normal! Otherwise, women aren’t going to do anything,” says Kathy.

Dr. Patel says women should watch for symptoms, including a new lump, skin changes, nipple...
Dr. Patel says women should watch for symptoms, including a new lump, skin changes, nipple discharge, or swelling.(Mayo Clinic)

A false sense of security provided by the word normal took away Kathy’s incentive to pay attention to the following warning that was also included in the results:

“Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in fifty percent of women. However, dense breast tissue can make it more difficult to detect cancers in the breast by mammography and may also be associated with an increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you to discuss with your health care providers your dense breast tissue and other breast cancer risk factors. Together, you and your physician can decide if additional screening options are right for you. A report of your results was sent to your physician.”

Arizona is one of more than 30 states that require providers to inform women if they have dense breasts. Kathy’s tests results included the required warning, but she is adamant the warnings don’t go far enough. After losing her left breast, she believes doctors should be required to have conversations with women to inform them that dense breasts can cause cancer.

The FDA confirms they are in the process of amending existing mammography regulations to include mandatory notifications and specific topics for women to discuss with their health care providers. Under the FDA’s Proposed Rule change, women with dense breasts would get the following warning:

Some patients have high breast tissue density (more glands than fat in the breasts), which makes it harder to find breast cancer on a mammogram. Your breast tissue density is high. Some patients with high breast density may need other imaging tests in addition to mammograms. Follow the recommendations in this letter, and talk to your healthcare provider about high breast density and how it relates to breast cancer risk, and your individual situation.” -Mammography Quality Standards Act.

Dr. Bhavika Patel with Mayo Clinic calls dense breast tissue “double jeopardy,” increasing the risk of cancer while making the cancer harder to detect. However, the Radiology Specialist says women should not panic. “As a breast imager, I am very wary of the fact this can cause a lot of anxiety to patients. How we message, this is very important. We don’t want 50% of women who get a standard mammogram to think something is wrong,” says Dr. Patel.

Mammograms remain the gold standard for detecting breast cancer. Women with dense breasts should discuss the possible need for additional tests with their provider, including ultrasounds or MRIs. The downsides of additional testing can include cost, false positives, or unnecessary biopsies.

Dr. Patel says women should watch for symptoms, including a new lump, skin changes, nipple discharge, or swelling.

Resources:

Dense breast tissue: What it means to have dense breasts - Mayo Clinic

DenseBreast-info, Inc. | Dense Breast Tissue Information Resource

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