Should a woman with dense breasts still get a mammogram?
Yes. Mammography is the only screening tool that has been demonstrated through large randomized trials to lower breast cancer mortality. Those trials included all breast densities. While mammography sensitivity is somewhat lower in women with extremely dense breasts, it is still the best modality for population-based screening. Also, mammography is the only test that can reliably detect suspicious calcifications. Such calcifications are often the first sign of in-situ cancers, which (in 20% of cases), coexist with otherwise invisible invasive cancers.
There is no recommendation that mammography be replaced with another test in any subset of the population.
The American Cancer Society, American College of Radiology, Society of Breast Imaging and American College of Obstetricians and Gynecologists, among others, recommend that all women have yearly mammograms beginning at age 40.
What should I do if I have dense breasts? What if I don’t?
If you have dense breasts, please talk to your doctor. Together, you can decide which, if any, additional screening exams are right for you. If your breasts are not dense, other factors may still place you at increased risk for breast cancer — including a family history of the disease, previous chest radiation treatment for cancer and previous breast biopsies that show you are high risk. Talk to your doctor and discuss your history.
Are there any tests that are better than a mammogram for dense breasts?
In breasts that are dense, cancer can be hard to see on a mammogram. Studies have shown that ultrasound and magnetic resonance imaging (MRI) can help find breast cancers that can’t be seen on a mammogram. However, both MRI and ultrasound, show more findings that are not cancer, which can result in added testing and unnecessary biopsies. Also, the cost of ultrasound and MRI may not be covered by insurance. However, patients with a higher cancer risk are more likely to benefit from additional testing.
Screening breast MRI has been shown to substantially increase the rate of cancer detection. It is recommended, along with mammography, in patients who are at very high risk (>20% lifetime risk of breast cancer) based on one of several accepted risk assessment tools that look at family history and other risk factors.
For patients at an “intermediate risk,” (equivalent to a 15% to 20% lifetime risk) a patient- centered shared decision –making approach is recommended between the patient and her provider and/or breast specialist. These intermediate risk patients include those with a personal history of breast cancer, a prior biopsy diagnosis of lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), or atypical ductal hyperplasia (ADH).
Screening breast ultrasound is not offered at many centers and may entail an out-of -pocket charge to patients. Small studies have shown a modest increase in cancer detection, but also a high rate of false positives resulting in benign biopsies. The choice to have this test should be made on an individual basis after a discussion of these risks, benefits, and costs.