Dr. Diana Pack

Dr. Diana Pack is a radiologist at Anne Arundel Medical Center. (Courtesy of Marcus Chacona, Baltimore Sun / January 10, 2012)

Women with dense breast tissue will now get an extra warning about cancer. Dense breast tissue, while common in women, can make it harder to detect breast cancer. A new state law requires doctors to send women with dense breast tissue a special letter warning of the danger. Together the patient and doctor can decide on what type of screening should be done. Dr. Diana Pack, a radiologist at Anne Arundel Medical Center, explains the new law.

What are requirements of the new breast density law and when did it go into effect?

The law, which went into effect Oct. 1, requires mammography centers to notify women if they have dense breast tissue. Maryland requires the following specific statement to be included in the letter that is sent home with women after their mammogram:

"The notice contains the results of your recent mammogram, including information about breast density. If your mammogram shows that your breast tissue is dense, you should know that dense breast tissue is a common finding and is not abnormal, with about half of women having dense or highly dense breasts. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of cancer. This information about the result of your mammogram is given to you to raise your awareness and to inform your conversations with your physician. Together, you can decide which screening options are right for you based on your mammogram results, individual risk factors, or physical examination. A report of your results was sent to your physician."

What is dense breast tissue and why should women be concerned about it?

There are several reasons to be concerned. Dense breasts have a lot of fibrous and/or glandular tissue but not much fat. Since both dense tissue and breast masses appear white on a mammogram, dense breast tissue can make the detection of breast cancer more difficult. This is analogous to finding a polar bear in a snow storm. Having dense breasts is not unusual, however. About 50 percent of women have dense tissue. While dense tissue is more common in younger women, anyone can have dense breast tissue. This is a finding that is detected on a mammogram and may differ from the feel of one's breasts.

Keep in mind that a study at the National Cancer Institute showed that breast cancer patients with dense breast tissue on their mammograms do not have an increased risk of death.

How could this law help with the detection of breast cancer in women?

Dense breasts appear to be associated with an increased risk of developing breast cancer. Typically, this alone does not put an individual at high risk. In other words, dense tissue is only part of the big picture. Other risk factors include a personal or family history of breast cancer, certain genetic mutations, prior chest radiation therapy such as for lymphoma and prior biopsy results showing atypical cells.

What happens after a woman is notified she has dense breast tissue? Are their requirements in the law for follow-up procedures?

If you are notified that you have dense breasts, it should prompt a discussion with your health care provider to assess if you need additional screening based on this and other risk factors. The American Cancer Society recommends that women have yearly screening mammograms beginning at age 40. Mammography is the only screening test proven to reduce breast cancer deaths. Some high-risk women may be advised to start screening earlier, have additional screening tests such as breast MRI, or enroll in a high-risk screening program.

What other states have breast density laws and why is it becoming more popular?

The grassroots effort for this movement has been fueled by seven women from six states, all of whom received a breast cancer diagnosis at a later stage because breast density limited the effectiveness of their mammogram. (Are You Dense Advocacy Inc.)

In June, Maryland became the seventh state to enact a law regarding breast density notification. There are now 12 states in all with breast density laws: Alabama, California, Connecticut, Hawaii, New York, Maryland, Nevada, North Carolina, Oregon, Tennessee, Texasw and Virginia. Connecticut was the first to pass this law in 2009. Some states are still in the process of passing this law.

The goal of this law is to detect breast cancer early, when the chances of survival are the best. In some women with other risk factors, dense tissue may prompt the use of additional screening tools to look for breast cancer.

andrea.walker@baltsun.com

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