Women’s health experts say normalizing the practice of sharing breast density data with patients can be lifesaving and hope the new rule by the U.S. Food and Drug Administration would level up the care women can access.
Breast density, which isn’t related to breast size or firmness, is an assessment of how much fibrous and glandular tissue is in the breast. It’s a common finding and does not indicate that there is anything wrong per se. In fact, about half of the women above the age of 40 have dense breasts, according to the Centers for Disease Control and Prevention.
The federal rule would require all health care facilities to notify patients of their breast density assessment in their mammogram report, which would raise awareness and help women better advocate for themselves.
This assessment matters because fibrous and glandular tissue is harder to see through –– to detect abnormal growths such as tumors –– on a mammogram compared to fat tissue. It’s why a patient with dense breasts may benefit from further breast cancer screenings, said Dr. Tarah Ballinger, a breast oncologist and associate professor at Indiana University Simon Comprehensive Cancer Center.
Ballinger likens it to trying to look for an object in your yard during a snowstorm as opposed to searching when it’s sunny and clear.
“A lot of what we're looking for on the mammogram are things called calcifications, which are kind of small build up in the ducts that can indicate an abnormal process is starting there. And those can be harder to see if there's a lot of that denser tissue or ‘snowstorm’ blocking that area,” Ballinger said. “Same thing with really small masses that have started. It's just hard to find them.”
Another factor, which many people may not be aware of, Ballinger said, is that women who have dense breast tissue have a higher breast cancer risk than women with less dense breast tissue.
“The more glands you have, the more cells you have. So, statistically, the more likelihood that something goes wrong and cancer can form,” she said.
A woman’s breast density can change overtime due to different factors including age.
Prior to this federal rule some states did not have any requirement to notify patients of their breast density in mammogram reports.
Other states passed recent legislation in anticipation of the federal rule. Indiana, for example, passed House Bill 1058 into law earlier this year, which mandated that patients be notified of their breast density. The notification would also inform patients with dense breasts that this decreases the sensitivity of their mammogram, and increases their cancer risk and invites them to talk to their provider about other options.
With the new FDA rule, all states will have to require notification.
Women’s health experts say the next frontier would be to ensure that health insurance covers any additional screenings patients may need.
The insurance coverage landscape is a patchwork. In the Midwest, states like Indiana, Illinois, Ohio and Kentucky have expanded coverage for some breast imaging, while Michigan, Missouri, Minnesota and Iowa have not.
Women’s health care providers hope this new rule will open up the door for more legislation to ensure uniform insurance coverage for adjunctive screening tests for women who need it.
Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.
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