By Vera Tweed
Health Radar A Publication of Newsmax Health
Vol. 5, Issue 8 / August 2015
At age 41, Chiqeeta Jameson was diagnosed with breast cancer.
Oddly enough, she was somewhat relieved. The diagnosis came from the fourth doctor she had seen over eight months.
After noticing a lump in her breast, Jameson was certain it was cancer because the disease ran in her family. But three different doctors discounted it because two mammograms were negative. She was repeatedly told “You’re too young to have breast cancer.”
But those first three doctors ignored the fact that Jameson has dense breast tissue, which can obscure cancerous growths on a mammogram. Finally, an ultrasound revealed a cancerous tumor the size of a walnut.
Fortunately, it had not spread to her lymph nodes, and the treatment — a lumpectomy to remove the tumor plus eight rounds of chemotherapy and 30 days of radiation — was successful. But it ended her ability to bear children.
Dense Breast Danger
“Mammography is adequate for women without dense breast tissue,” says Judy Dean, M.D., a leading radiologist who specializes in breast imaging. But for women with very dense breasts, she tells Health Radar: “There’s an 18-times higher risk of having a cancer missed by mammography.”
That’s because both dense tissue and cancer appear white on mammograms. Consequently, if a mammogram is negative but breasts are dense, an ultrasound should always be the next step in annual screening.
This doesn’t change the fact that mammograms are the first line of screening, as some breast cancers may be detected on a mammogram but not on an ultrasound. While well-documented and not even disputed, these facts are often overlooked.
There is no way for a woman, or a doctor, to tell if breast tissue is dense unless a mammogram is done. Results always include breast density, classifying it from 1 (least dense) to 4 (extremely dense), or from A (least dense) to D.
In 2009, Connecticut passed legislation requiring that a woman be told her breast density if she has a mammogram. Since then, some other states have passed similar laws. If density is not on your mammogram report, ask your doctor.
“First, know your breast density,” says Dr. Dean. In addition to enabling proper screening, there’s another reason.
“Density is, in and of itself, a strong risk factor for cancer, stronger than family history” says Dr. Dean.
Women with other risk factors, such as carrying a BRCA1 or BRCA2 gene, having a mother or sibling who had breast cancer, or having had radiation treatment early in life, require additional evaluation.
If you fall into one of these very high-risk categories, Dr. Dean recommends asking for a formal risk assessment, usually done at a cancer center. A contrast MRI, where a dye (without radiation) is injected, is used to screen women who are at very high risk, but an ultrasound may also be done.
What Tests Do You Need?
There is widespread disagreement about how often mammograms should be performed. Dr. Dean recommends annual mammograms starting at age 40 for most women.
Breast density is reported on a scale of 1 (lowest density) to 4 (highest density), or A (lowest) to D (highest). If there are no personal, high-risk factors, says Dean, this is what the categories mean:
1, 2, A, or B: An annual mammogram is sufficient. 3, 4, C, or D: Both a mammogram and an ultrasound should be done annually.
Women with breast implants, which can obscure tissue in mammograms, should have annual ultrasounds in addition to mammograms, Dr. Dean says. For more information about your individual risk, use the National Cancer Institute’s Breast Cancer Risk Assessment Tool at www.cancer.gov/bcrisktool.