Dense breast tissue is common. But dense breast tissue is associated with increased risk of breast cancer and increased difficulty in detecting that cancer by mammography (falling from near 90% sensitivity in non-dense breasts to less than 70% in dense breasts).

 In Oregon the law states that women with dense breasts must be notified. It does not mandate that insurance pay for supplemental (ultrasound or MRI) imaging. And, as yet, there is not sufficient research data to provide definitive recommendations concerning dense breast management.

 In addition to breast density, many factors influence breast cancer risk, including age, family history, results of breast biopsies, age of menstrual onset and age when birthing first child.  There are calculators which can take this information to calculate a 5 year and lifetime risk.  If either are significantly elevated, additional imaging with ultrasound is recommended.

 Tomosynthesis (3 dimensional mammography) can increase the invasive cancer detection rate by 30% over standard mammography while decreasing the recall rate for further imaging.  Ultrasound can improve cancer detection rates but generates many false positives.  MRI is generally used in women positive for the BRCA mutation, or with a history of carcinoma in situ, or with chest irradiation before age 30.  If you have dense breasts, talk to your health care provider about what is best for you.

Paid Advertising Column By Kay E. Case, M.D.
Physician and Surgeon, Women's Health Care

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