Breast Density Considered Greater Risk Factor for Breast Cancer than Family History

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The month of October is known as Breast Cancer Awareness month. And while various people are sporting pink ribbons, it is important to note that 1 in 8 women will develop invasive breast cancer during her lifetime; of which 85 percent have no known family history of the disease. Therefore, retired special education teacher in Susquehanna Township, Kathie Thomas claims: if your breasts have dense tissue, you should know it.

Thomas had been consistently getting annual mammograms with the results indicating no sign of cancer. However, it was not until she received results from a biopsy on scar tissue on her kidney did she learn that she had some form of female cancer. An MRI of her breast showed the source, lobular carcinoma and what was most surprising to her and her doctors was that the cancer was Stage IV and had metastasized to her bones. 

“I had just had my mammogram four months before and nothing showed up. Apparently, I had breast cancer for several years,” said Thomas, whose mammogram results over the last three years told her otherwise. It wasn't until Thomas had an MRI and learned that dense breast tissue can disguise a growing cancer during a mammogram screening.

This is due to dense breast tissue comprising of considerably more fibrous and glandular tissue than fat. On a mammogram the fibrous, glandular tissue appears white, as do cancer cells. Thus, tumors can remain concealed by the dense tissue. It also delineates why Thomas and thousands of other women with dense breasts are at a higher risk of contracting breast cancer and finally being diagnosed at later stages of the cancer.

According to Dr. Thomas Kolb, who has been featured in the Wall Street Journal and is a New York radiologist who discovered in his research on breast cancer detection, “mammograms missed 60 percent of cancers in women with the densest breast tissue that were found on ultrasound.” 

In response to the growing concern as to the accuracy of mammography for women with dense breast tissue, advocacy groups throughout the nation are campaigning for legislation that requires mammogram reports to inform women whether they have dense breast tissue (there are four levels). Four states have passed, “dense breast notification” laws (New York, Connecticut, Texas and Virginia) and at least twelve other states and Congress are considering similar legislation.

Yet some physicians and radiologists are against the legislation believing that it will trigger an unnecessary anxiety in women and cause them to ask for further testing leading to more false-positives. Not to mention, insurance companies are wary of the cost of supplemental testing. For instance, according to the American College of Radiology, the national Medicare average recompensation for a film mammogram is $81, a breast ultrasound is $99 and MRI of both breasts is $716.

However, Mayo Clinic preventive medicine specialist Dr. Deborah J. Rhodes argues otherwise, “Dense breasts is a greater risk factor [for breast cancer] than having a mother or sister with the disease. The vast majority of women are capable of hearing this information and not freaking out.” 

While Thomas enthusiastically concurs, "When you get your blood work back, no one hides from you a high cholesterol level because they think you’ll panic into believing you’ll have a stroke or heart attack," she said. "It’s a finding that allows you to have an informed discussion with your doctor. So why shouldn’t I know my mammogram’s finding that I have dense breasts? Let me talk with my doctor about the risks and decide if I need an ultrasound."

The state of Pennsylvania is now considering dense breast legislation. Senate Bill 358 requires reporting by radiologists of breast tissue density on mammograms. The bill has passed the Senate and is now awaiting approval by the House of Representatives. The Pennsylvania Breast Cancer Coalition is leading the campaign for the legislation in an attempt to give women like Thomas a choice they never had.

“If only I had known that my dense breast tissue would prevent my mammograms from detecting breast cancer, I would have at least had a conversation with my doctor, and would have asked for an ultrasound to establish a baseline to compare to over the years,” she said.

Instead, Thomas now looks to undergo various forms of treatment including radiation, medications, PET scans and the nerve-wracking news of blood work results to cope with what her doctors tell her is terminal. Yet Thomas remains focused on what is within her grasp of control.

"No one thought people with an HIV/AIDS diagnosis would live long, but with advances in medicine they can now live a full life and that’s how I view my cancer. So far, I’m responding well to treatment.” And if her resolute spirit and faith remains in control, there's always a possibility her voice will still be around. However, it is best to listen to that voice now.