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New law alerts women to risk posed by dense breasts

Lisa Zybert has dense breasts.

It is a condition that is not uncommon and is completely benign.

But having dense breast tissue can mask cancers on mammograms, and when women know their breasts are dense, physicians say, that awareness is a valuable tool in the fight against breast cancer.

When Zybert, a neonatal intensive care nurse who lives in Angola, went for a routine mammogram in January, she was handed a pamphlet explaining a new state law that requires health care facilities to notify patients when they have dense breasts.

When she got the pamphlet, it rang a bell.

“I do remember something was said about my breast tissue years ago,” she said, “but it did not require further testing. It was never brought up again until now.”

As a health care professional, Zybert said, she knew enough to ask questions.

“I do think it warrants a talk with your doctor as to whether you might be at increased risk … It will make me more aware of keeping a regular mammogram schedule and making sure I keep the appointments and not push them off,” she said.

New York this year became the fourth state in the country to require health care facilities to notify women who are categorized as having such tissue in their breasts.

The notification requirement is intended to improve breast cancer detection and prevention by educating patients about dense breast tissue and how such tissue could conceal abnormalities during mammography procedures.

“It’s another piece of information, just like your family history, your reproductive history, your prior history of any breast biopsies, that you put together and discuss with your physician about what the appropriate next steps are,” said Dr. Ermelinda Bonaccio of Roswell Park Cancer Institute.

Breasts are made up of a mixture of fibrous and glandular tissue, as well as fatty tissue, according to the American College of Radiology. They are considered dense if a woman has more fibrous or glandular tissue, and density may increase with age.

Doctors want to be clear: Dense doesn’t mean firm.

Also, having dense breast tissue is normal, said Dr. Claudia Fosket, women’s imaging specialist and diagnostic radiologist at Southtowns Radiology. About 10 percent of women have highly dense breast tissue. Another 10 percent have fatty tissue. The rest, she said, fall somewhere in between.

Dense breast tissue can hide cancer on a mammogram because that density shows up as white on a mammogram.

The problem: So does cancer.

“Someone once said it’s like looking for snowmen in the North Pole,” Fosket said. “You’re looking for something white on a white background. It’s very difficult to do.”

Fatty tissue shows up gray and is less likely to camouflage tumors.

With the state law that took effect in January, radiology professionals are required to inform women if their breasts are dense. Patients are then provided materials to explain breast density, and additional screening may be recommended.

Prior to the law, breast density information was routinely included in mammography reports sent to the patient’s OB-GYN, but it was rarely seen by the patient.

Connecticut was the first state to enact the Breast Density Law in 2009 after a vigorous campaign waged by an education administrator from Woodbury who was diagnosed in 2005 with breast cancer at age 51. Her doctors, she said, never told her she had dense breasts, nor did they warn her the dense tissue could make her mammograms less reliable.

“Are You Dense?” became the rallying cry that increased women’s awareness and helped pass the country’s first Breast Density Law.

What is the reaction of women when told they have dense breast tissue?

“Most times they know,” said Sue Hohl, radiology technician at Southtowns Radiology in West Seneca. “I always start out by telling them there is a new law in New York State. Then I tell them their doctor has always been notified on the mammography report that they have dense breast tissue.”

The bottom line, said Hohl, is that women of all breast tissue types must be diligent with mammography exams.

Studies have shown that having high-density breast tissue increases a woman’s risk of developing breast cancer by four to six times. But dense breast tissue does not increase cancer’s mortality rate, according to a study published in August 2012 by the Journal of the American Cancer Institute. The study included more than 9,000 women ages 30 and older with a confirmed breast cancer diagnosis made between January 1996 and December 2005.

While mammograms have been credited with reducing cancer deaths by 30 percent since 1990, they are still not perfect, said Bonaccio of Roswell Park.

“There are cancers we do not find on mammography, and some that we do find but not early enough to save the woman,” she said.

Opponents of the legislation – insurers and medical groups – are concerned the additional information and testing will raise costs while unduly alarming women. Connecticut requires that insurance companies pay for these additional studies if performed. New York does not.

“We can’t do breast MRI on everybody,” said Fosket of Southtowns Radiology. “The time we do breast MRIs is when someone was diagnosed with breast cancer, and we want to make sure it is only in one spot and not multi-focal cancer or in the other breast. We also use MRIs for women with a very high risk from a strong family history.

“When somebody has really dense breasts and a strong family history, ultrasound is a very, very good second test, because there are things that show up on ultrasound that don’t show up on a mammogram.”

So what should you do if you have dense breasts?

Fosket offers this advice: “If you come in feeling a lump, and you have dense breasts, you’ll have an ultrasound,” she said. “If you come in with dense breasts, and you’ve never felt anything, and you don’t have a family history, you’ll get a mammogram. But if you have a strong family history, at the very minimum, do an ultrasound.”