Breast Density and Mammograms

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

MARCH 12, 2018

  Some of you may be aware of the recent discussion about breast density and the efficacy of mammograms. The basic issue is that younger, usually pre-menopausal women, tend to have dense breasts. Mammograms are often less effective in this situations; the description is: "It's like trying to see a polar bear in a blizzard." As women go through menopause, their breast tissue changes, and the mammograms films become easier to read.

  There was a court case about this some years ago with a woman contending that she should have been notified that her mammogram, read as normal, actually turned out to be not entirely accurate. There was something there which was not seen. (Sidebar note: This is sadly not a super rare situation in radiology of any kind. Sometimes, a worrisome "something" is only seen in hindsight when the film as changed more.) In response, thirty states, including Massachusetts, now require some kind of notification to women in this situation. Those regulations vary; some states insist upon a person-specific letter while others allow a letter of general explanation.

  Here is the problem: It can be extremely upsetting to receive, by mail, a mammogram report (saying all is well) with an accompanying letter that seems to negate the value of the test. Many women have no idea how to respond to this. Does it mean that I actually have a lurking tumor? Does it mean I should have a repeat exam? Do I need to be concerned?

  This article from Medpage Today addresses these questions:

Breast Density Notices Confuse Patients
— Surveyed women say notifications are difficult to understand,

Women often found radiology dense breast notifications (DBNs) difficult to understand
and interpreted the notice incorrectly, results of a small survey showed.
Overall, 49 of 58 women who received DBNs remembered the notifications, and all 30
women who completed a follow-up telephone survey remembered that the notice stated
they had dense breasts. However, none of the survey participants mentioned details
about the degree of breast density or how to obtain additional information, according to
Christine M. Gunn, PhD, of Boston University, and colleagues.
From 10% to 34% of the survey participants, all of whom lived in Massachusetts, had
awareness about other components of a Massachusetts legislative initiative to increase
women's knowledge and understanding of breast density, they wrote online in Patient
Education & Counseling.
"While many women in this study recalled receiving a dense breast notification, the
intention of increasing breast-density awareness was achieved in few," the authors
concluded. "This single-center study suggests that notifications can generate confusion,
without increasing awareness about the clinical and radiological risks of breast density"

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