June 14, 2019

What Patients Can Expect: Future of Breast Cancer Screenings

Here are some numbers that relate to breast cancer detection and self care:

40 – the age recommended for women to have annual mammograms.
50 – the percentage of cancers in women with dense breast tissue that can be missed by standard mammograms.
40 – the percentage of women who have dense breast tissue

What is dense breast tissue?

The Breast Imaging Reporting and Database Systems, (BI-RADS) which reports the findings of mammograms, also includes an assessment of breast density by four groups:

Almost entirely fatty: The breasts are made up of mostly fat and contain little fibrous and glandular tissue. This means the mammogram would likely show anything that was abnormal.
Scattered fibroglandular densities: The breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue.
Heterogeneously density: The breasts have many areas of fibrous and glandular tissue that are evenly distributed through the breasts. This can make it hard to see small masses in the breast.
Extremely dense: The breasts have a lot of fibrous and glandular tissue. This may make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue.

Breast density is not based on how your breasts feel during a self-exam or a doctor's physical exam. However, breast density is determined through a mammogram.

Women who are categorized as "heterogeneously dense" or "extremely dense" are considered to have high breast density and by Indiana law are notified that they have dense breasts. This is important because the dense tissue can hide a cancer.

Cancers appear as white objects in a breast x-ray. If a white object is shown on a white or dense background it’s much harder to see than if presented on a dark or background. Improved screenings can better detect those hard to see cancer spots.

Early Detection: Since 1990, the death rate from breast cancer has significantly declined. The reason? Early detection and more sophisticated breast screenings.

Following are some responses from Doctor Patterson about those advances:

When 3D mammography (digital breast tomosynthesis) was introduced it was called a revolutionary new screening and diagnostic breast-imaging tool with the ability to improve early detection of breast cancer. How does that work?

“Tomosynthesis is a new and improved mammogram and starting to replace the 2D mammogram. We know it’s a better mammogram and can better detect cancer. Most IU Health centers have 3D mammograms. 3D mammography is appropriate for most women, but it is acceptable for women to ask it they are a good candidate for 3D mammography.”

It’s been reported that the more dense the breast tissue, the greater the risk of masking cancer detection. Ultrasound, when combined with mammography, can increase the accuracy and detection of breast cancer in dense breasts by 35.7 percent. What else can be done to help patients know that they have received the best scan possible?

“We are now being trained on Automated Breast Ultrasound Screening (ABUS). IU Health is the first provider in the state to use this technology. Our overall goal is personalizing what is best for our patients. Using ultrasounds for breast cancer screenings is not new, but the equipment is more sophisticated. What we know is breast ultrasound can detect more cancers when added to mammography. As the technology has improved with automated ultrasound, the images are so much better and we can decrease the false positive rate. Another advantage to this type of ultrasound is standardization of the exam. Handheld ultrasounds are time consuming are vary based on who is performing the exam. Now the automated ultrasound done by a technologist in less than 15 minutes, and read on a workstation by a radiologist. We hope to begin scheduling patients by the end of the month. This will be for women who have high breast density and an average risk of breast cancer.

How do health providers provide the best follow up screenings for patients?

“A lot of IU Health facilities offer risk assessments. So if the patient for instance, has a family history and may be at a high risk, the patient may be recommended for additional screening with breast MRI in addition to mammograms. Other patients who are not high risk but have dense tissue may be recommended for breast ultrasound in addition to mammograms. Our ultimate goal is to personalize what is right for each patient based on individual risk and breast density. We encourage patients to talk to their doctors about the best option.

Additional resources about dense breast tissue:

-- By T.J. Banes, Associate Senior Journalist at IU Health.
Reach Banes via email at T.J. Banes or on Twitter @tjbanes.