Claudia Reynders, MD
Q: My mammography results show I have dense breasts? Why is this important to know? Do dense breasts increase my risk of breast cancer?
A: Massachusetts passed a law in 2014 requiring mammography results letters to include mention of a patient’s breast density. Half of all women have dense tissue, so it’s really a normal variation. Women with dense tissue have a very small increased risk of developing breast cancer. The most important aspect of knowing that you have dense tissue is understanding that your mammogram can be more challenging to interpret. Fortunately, we have some very effective tools in our screening toolbox for women with dense breasts, including tomosynthesis (3D mammography), which is widely available and terrific for evaluating dense tissue, and breast MRI, which is used with women who are found to be at especially high risk for developing breast cancer. For women who cannot undergo a MRI, a screening ultrasound can be a useful option. Incidentally, Massachusetts was way ahead of the curve on density notification. A federal law mandating that women be notified if they are found to have dense tissue only recently went into effect in September 2024.
Q: If I have dense breast tissue, do I need further screening beyond an annual mammogram?
A: If you are at average risk of developing breast cancer, current mammography technology is usually sufficient. Tomosynthesis came into use about 10 years ago and is now widely available, including at our Breast Health Center at Beth Israel Lahey Health Care Center – Danvers. Previously, a mammogram consisted of just four X-rays (two views of each breast). Tomosynthesis allows radiologists to see multiple thin-slice images of the breast tissue, making it much easier to detect subtle changes. Women should check with their screening center to ensure they are receiving the latest technology when they have their mammograms.
Q: I don’t have a family history of breast cancer. Do I really need to have mammograms?
A: A common misconception is that most women who develop breast cancer have a family history of breast cancer. In fact, approximately 80 percent to 85 percent of women diagnosed with breast cancer do not have a family history of this disease. Being female is the single most important risk factor for developing breast cancer. One in eight women will develop breast cancer in her lifetime. However, if caught early, the chances of survival and cure are generally much greater.
Q: I’m confused. I keep reading different recommendations on what age to start having mammograms and then how often I should return for one. What is the correct recommendation?
A: You’re right. There have been a variety of different recommendations coming from various organizations over the past few years. Major studies have shown that for women of average risk, beginning annual screening mammograms at age 40 can have the largest effect on their chance of surviving a breast cancer diagnosis.
Q: My mother had breast cancer at age 40. Should I start getting screened earlier?
A: Yes. The current recommendation is to start annual screening 10 years younger than the age at which your mother was diagnosed with breast cancer, so you would start at age 30. For women who need to start screening younger than age 30, breast MRI is the study of choice.
Q: I have heard a lot lately about “risk assessment.” What does that mean?
A: Breast cancer screening is becoming increasingly personalized, rather than “one size fits all.” More and more, health care systems are offering risk assessment questionnaires to female patients in order to identify those at greater than average lifetime risk for breast cancer. You can ask your primary care provider if your health care system offers these types of assessments. If you have a strong family history of breast cancer — for example, a mother, sister or daughter with breast cancer — especially if you are pre-menopausal (before the age of menopause), you would especially benefit from a risk assessment.
Please consider booking your annual screening mammogram today. Mammograms save lives!
Claudia Reynders, MD, is a breast radiologist with Beverly Radiology Associates at the Breast Health Center at Beth Israel Lahey Health Care Center – Danvers. To learn more about the Breast Health Center, visit https://beverlyhospital.org/locations/bilh-care-center-danvers/breast-health-center.