How to Talk About Dense Breast Tissue – A Guide for Technologists and Sonographers

How might this affect a Technologist’s day to day interaction with patients?

The law will require mammography facilities to include information about breast density in the result letter sent to patients with dense breast tissue. The letter will include:

1. The information that they have dense breast tissue
2. The facts that half of all women have dense breast tissue and that dense breast tissue may make their mammogram more difficult to read
3. Encouragement to talk about breast cancer risk factors and breast cancer screening options with their health care provider

There is a possibility that you will be asked about dense breast tissue by your patients when they come in for their screening exam or diagnostic work up because they heard about this new law or received the letter.

Here are some questions patients may ask Technologists:

What is dense breast tissue?

Answer: Breast density is a description of the composition of breast tissue on a mammogram. All breasts are composed of fibrous and glandular tissue and fatty tissue. On a mammogram the fibrous and glandular tissue appears white and the fatty tissue appears black. A dense breast contains mostly white fibrous and glandular tissue with little fat.

Radiologists classify breast density on mammograms into four categories: almost entirely fatty, scattered areas of fibroglandular density, heterogeneously dense, and extremely dense. Women whose mammograms show heterogeneously dense or extremely dense tissue are
considered to have “dense breasts”.

Breast density in the United States:

• 10% of women have almost entirely fatty breasts
• 40% of women have scattered fibroglandular tissue density
• 40% of women have heterogeneously dense breasts
• 10% of women have extremely dense breasts

Why do I have dense breast tissue, can I change this?

Answer: You are just built this way and your breast density will probably slowly decrease with time. For the most part, breast density is not something you can control. However, hormone replacement therapy could increase your breast density. Consider discussing the risks and benefits of hormone replacement with your provider if you are concerned.

Does this mean I will probably get breast cancer?

Answer: No! But, having dense breast tissue can increase your risk for breast cancer slightly. There are many things that can increase your risk for breast cancer and this is just one of them. As half of women have dense breast tissue, you are not alone. Dense breast tissue can also hide some types of breast cancer. Women with dense breasts may consider additional screening tests to help detect cancer early.

If my mammogram is difficult to read, why should I get one?

Answer: Mammograms are not perfect, but they have been proven time and time again to save lives, including the lives of women with dense breast tissue. It can be helpful to get a 3D mammogram if that is available, as the 3D technology improves cancer detection and reduces recalls from screening. In addition to a mammogram, some women have an extra screening exam every year, usually an MRI. It is recommended that women consider extra yearly screening if they have many risk factors for breast cancer. If you are worried that you might be at high risk for developing breast cancer, you can talk to the radiologist or your health care provider for more information.

What are the supplemental testing options?

Answer: Regardless of breast density the only medical imaging test proven to reduce breast cancer deaths is a screening mammogram. The WSRS and other groups recommend that all women have a mammogram every year starting at age 40. Women with dense breasts or other factors that increase their risk may consider supplemental screening tests described below.

Digital breast tomosynthesis (DBT), also called 3D mammography, creates image slices through the breast making some abnormalities easier to see. It looks and feels just like a mammogram and can be performed at the same time as a standard mammogram but not all facilities have this technology yet.

Ultrasound uses sound waves to create a different type of image of the breast. Some facilities offer screening breast ultrasound in addition to mammograms.

Magnetic resonance imaging (MRI) uses radio signals, magnets and contrast injected in a vein to create images of the breast. It can help find cancers that can’t be seen on mammography.

What is this all going to cost me?

Answer: The State of Washington passed a bill in 2018 requiring insurance companies to cover DBT (3D mammography) the same as standard screening mammograms. The cost of any ultrasound or MRI screening tests will be variable and depend on your insurance plan and the availability of testing in your area. All screening tests may find things that are not cancer, at times leading to additional imaging or biopsy and additional costs. However, the goal of screening is to detect cancer early when it can be treated more quickly, with fewer drugs and costs, and provide the best chance for cure.

Thanks to Seattle Cancer Care Alliance for providing us with this downloadable handout:  SCCA density tech resident guide 11.7.18