As young women, we are indoctrinated with the fear of breast cancer. We learn that one of the very things that society has told us helps define our femininity can cause us great harm. As dutiful women, we’re encouraged to get annual mammograms to detect abnormalities. While breast cancer is a serious concern, it is not the leading cause of death for women — cardiovascular disease holds that distinction. However, breast cancer screenings and modern treatment protocols have significantly improved outcomes for those diagnosed.
The guidelines for breast cancer screenings have evolved over the years alongside advancements in technology. Some argue that excessive screenings can lead to unnecessary anxiety and false positives. Additionally, there has been ongoing debate about the accuracy of mammograms, particularly for women with dense breasts. This blog offers some insights into the current perspectives on breast cancer screenings.
Breast Cancer Prevalence
The National Cancer Institute estimates that more than 300,000 women will be diagnosed with breast cancer and 42,250 will die in the U.S. this year. About 1 in 8 women will develop breast cancer in her lifetime While incidence rates are rising by about 1% annually, death rates have been decreasing by a little more than 1% each year, thanks to advances in screening and treatment.1
Mammographies
Traditional mammograms use X-rays to create 2D images of the breast. Over the past 28 years, the U.S. Preventive Services Task Force (USPSTF) has frequently updated its guidelines on when and how often women should receive mammograms. Currently, the recommendation is for women aged 40 to 74 to undergo a mammogram every other year, barring other risk factors.
Mammograms are the most effective screening tool for women without additional risk factors, with an overall accuracy rate of about 84%. However, accuracy can drop to as low as 30% in women with extremely dense breasts — a condition affecting half of women in the U.S. Not only is detection more difficult in dense breasts, but these women are also at higher risk of developing breast cancer.2
3D Mammograms are a newer imagery method that takes X-rays from multiple angles to produce a detailed 3D representation of breast tissues. They can detect breast cancer at higher rates and earlier stages when compared to traditional 2D mammograms, and also reduce the number of false positive results, leading to fewer unnecessary tests after initial screening and unneeded worry.
Dense Breasts
Breast tissue is composed of glandular, fibrous connective, and fatty tissues. When a breast has more glandular and connective tissue than fat, it is considered dense. Dense tissue can obscure cancerous masses in mammograms, as both tissue types appear white on the images, making detection difficult. Black women are even more likely to have dense breasts. In addition, just having dense breast tissue increases a woman’s overall risk of developing breast cancer.
Approximately 50% of women over 40 in the U.S. have dense breasts. Among women with heterogeneously dense breasts, 25% of cancers may be missed, and for those with extremely dense breasts, up to 40% of cancers may go undetected.3 Fortunately, the FDA now mandates that mammography facilities notify patients if they have dense breasts, although many women are not informed of the associated risks or advised to seek additional testing. Plus, many doctors and medical facilities have not changed their protocols when screening women with dense breasts. Usually, the burden rests on the patient.
Ultrasound
Ultrasound is another tool that uses sound waves to create images of the breast and is particularly helpful for women with dense breasts. It can detect changes difficult to identify in mammograms, such as fluid-filled cysts. When used alongside mammograms, ultrasound can improve breast cancer detection by over 55% in women with dense breasts.2
3D Mammograms
3D mammograms, or digital breast tomosynthesis, use X-rays to create a 3D image of the breast, making it easier to detect cancers hidden in dense tissue. This technique is considered a standard of care and is often more comfortable than traditional mammograms. Studies show it significantly improves the detection of invasive cancers while reducing the need for additional testing.
MRIs
Magnetic resonance imaging (MRI) is the gold standard for breast cancer screening, especially for women with dense breasts or a high risk of cancer due to family history or genetic mutations. MRIs use radio waves and a magnetic field to create highly detailed images of the breast, especially soft tissue. MRIs are better at distinguishing between normal and abnormal soft tissue than other imaging tests, don’t expose patients to radiation, and usually detect abnormalities earlier than mammograms.
Screening Gap
A recent survey revealed a significant gap in breast cancer screenings, with 72 million women having delayed or skipped their recommended screenings. While 90% of American women recognize the importance of regular health screenings, 41% have delayed breast cancer screenings due to factors like anxiety, lack of time, or concerns about discomfort.4
Education & Legislation
Organizations like DENSE (Density Education National Survivors’ Effort) have been working to raise awareness about the challenges of detecting breast cancer in dense tissue. Some states have passed laws mandating insurance coverage for supplemental screening like MRIs for high-risk women, while others have reduced out-of-pocket costs for medically necessary scans. Several bills, such as the Access to Breast Cancer Diagnosis Act and the Find It Early Act, are also being considered in Congress to reduce the financial burden of these screenings.
There are countless, heartbreaking stories of women who did all of the right things. They conducted self-exams, had annual OBGYN appointments, and had regular mammograms. However, their screenings did not detect abnormal tissue, breast cancer diagnoses were not made early, and their health suffered dramatically.
Advocacy
Despite advances in screening, many women with dense breasts still face barriers to early detection. Supplemental testing, like MRIs, is often not covered by insurance unless other risk factors are present, leaving patients to pay out of pocket. MRI machines are also harder to find, especially in rural areas. Even when doctors are aware that mammograms may miss cancers in dense breast tissue, they sometimes rely solely on them, increasing the risk of late detection.
Conclusion
Technologies for breast cancer detection and treatments have come a long way and saved many lives. However, there is still much to be done to increase the number of women who get regular breast screenings and to ensure women have accurate information to make informed decisions about their health.
If you, like me, have dense breasts or a family history of breast cancer, I encourage you to discuss your options with your doctor and explore appropriate screening methods. Although false positives can be concerning, I prefer having detailed information to ensure I understand my health and the options available. As technology advances, we can hope for more affordable and accessible MRI solutions in the near future.
