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Breast density and breast cancer

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Breast density is correlated with breast cancer: a denser breast is more apt to harbor cancer—and to hide it from mammograms. Elizabeth Limbach has a lengthy article at AlterNet:

One in eight. That’s how many women will be diagnosed with breast cancer in her lifetime, according to the National Cancer Institute (NCI). This grim statistic lands in the spotlight during Breast Cancer Awareness Month, which is currently underway.

But, for all of the awareness raised about breast cancer over the years, there’s a certain term that is largely left out of the lexicon surrounding breast cancer,the most common cancer in women. It’s a term Connecticut resident and cancer survivor Nancy Cappello has spent nearly a decade fighting to retrieve from the shadows and inject into the conversation. This term is “breast density.”

“If you look in the news this October, it’ll be pink, pink, pink for Breast Cancer Awareness month,” says Cappello. “I call it breast densityunawareness—many women still do not know of breast density, or if they’ve heard of it, they don’t know what it really means to them.”

Breast density refers to the ratio of tissue to fat in a woman’s breast. A dense breast has more fibroglandular tissue and less fat. Forty [3]percent of women have dense tissue, according to the American College of Radiology Imaging Network (ACRIN), which is significant because these women are five times more likely to develop breast cancer. They’re also less likely to have it detected on a mammogram.

A January 2011 Mayo Clinic study [4] found that mammograms fail to find 75 percent of cancer in women with dense breast tissue. The primary cause of “false-negative results” in mammograms is high breast density, according to the NCI.

However, until recently, it was standard practice nationwide for doctors to keep information about breast density from patients, and as a result many people with dense breasts do not have cancer detected until it is well developed.

While breast density—and the ineffectiveness of mammograms on dense breasts—is not new, in recent years a battle has arisen to bring unprecedented attention to the issue. As a result the standard practice of keeping breast density knowledge a secret from women has begun to change, but not without a surprising amount of opposition. On the frontlines of resistance is the American College of Radiology (ACR), the nation’s principal association of radiology professionals, an organization that benefits financially from mammograms.

The Status Quo

When Cappello was diagnosed with stage-three breast cancer in early 2004, she was baffled. Less than three months earlier, she’d received normal results on her mammogram, just as she always had from her annual screenings, which she was diligent about. Her doctor found a lump during a standard manual exam that turned out to be cancer that had spread to 13 lymph nodes and most likely been developing for years.

“What do you mean I have breast cancer?” she recalls asking her doctor. “What happened? I just got a mammogram that says ‘we are pleased to tell you that your results are normal.’”

The answer she was given perplexed her further. She was told that she had dense breasts, and that dense tissue shows up as white on a mammogram and can “mask,” or obscure, cancer, which also appears as white. (Santa Barbara radiologist Judy Dean has said [5] it has been compared to trying to find a snowball in a blizzard.) Why, Cappello demanded, hadn’t she heard of breast density, or been told that she was affected by it?

Simply put, most doctors do not share this information with women. Ninety-five percent of women don’t know their breast tissue density, and less than one in 10 doctors inform their patients of their density, according to a May 2010 survey conducted by Harris Interactive [6].

Under current federal law, radiologists must note a patient’s breast density when reporting mammogram results to the referring physician. The law also requires radiologists to send patients a letter (known as a “lay summary”) with their mammogram results—but this letter does not include information regarding breast density, or how the presence of dense tissue could render the mammogram inconclusive.

So, while a woman’s mammogram provider and her physician know whether she has dense tissue, often the patient herself does not.

Radiologist Thomas Kolb explained the problem with this practice at a press conference [7] at the New York Capitol in spring 2012. In 1998 and 2002, Kolb published research that found similar results as the aforementioned Mayo Clinic study about the effectiveness (or lack thereof) of mammograms on dense breasts. While mammograms were able to detect cancer in 98 percent of women with non-dense breasts, he found that 60 percent of cancer in dense breast was “mammographically occult or missed.”

“We as radiologists report to physicians and patients…knowing full well that if a woman has non-dense breasts we are 98% accurate but if she has dense breasts, and were to have a breast cancer, we would only be 40% accurate in our diagnosis,” he said. “Worse, by not detecting her breast cancer we allow it to grow until her next mammogram—or two or three—or until it becomes palpable, which translates to, at a minimum, double the size at which it could have been detected with imaging. However, this information is never directly transmitted to the patient.”

As Cappello was told, patients aren’t notified largely because it is not standard procedure for this information to be included on the lay summary they receive after a mammogram.

As for why the referring doctor hasn’t traditionally told patients (despite the fact that the report they receive from the mammogram provider does include density information), Hospital of Central Connecticut radiologist Jean Weigert says it’s possible that many of doctors have not been educated about density. . .

Continue reading.

Written by Leisureguy

24 October 2013 at 11:38 am

Posted in Health, Medical, Science

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