Breast Density and Cancer Risk: What National Regulations Mean for you

By Dr. Janet Yeh

Last month, new regulations under the Mammography Quality Standards Act (MQSA) took effect, mandating that radiologists document breast density in their mammography reports. This initiative standardizes practices that have already been implemented in several states, including New York. If your mammography report indicates that you have dense breasts, what implications does this have for you?

When reviewing a radiologist’s mammography report, one of my main focuses as a breast surgeon is breast density, which reflects the proportion of glandular tissue in the breast. Breast density, which is genetically determined like hair and skin color, can only be assessed through mammography and cannot be evaluated visually or by touch.

Radiologists classify breast density into four categories: fatty, scattered fibroglandular, heterogeneously dense, and extremely dense. The first two categories are classified as non-dense, while the latter two are considered dense. The level of glandular tissue in the breast has significant implications for breast cancer risk in two ways. First, individuals with high breast density face a slightly increased risk of developing breast cancer. Second, higher density levels can obscure mammography images, complicating the identification of tumors.

Despite this, mammograms are still the gold standard for breast cancer screening and diagnostic imaging.

While these statistics may seem concerning, it is important for women not to panic. Diagnostic technologies have advanced significantly, enabling earlier detection of potential cancers in women with dense breasts. At LHGV, we offer a range of supplemental imaging options that provide a more comprehensive understanding of breast tissue that may enhance a mammogram. Modalities such as ultrasound and MRI are available to offer additional internal images, regardless of breast density.

Our breast radiologists also specialize in contrast-enhanced mammography, which delivers imaging comparable to MRI. This procedure involves administering an intravenous iodine contrast agent, allowing tumors in the breast to become more visible by highlighting vascularity and tissue activity. This option is particularly beneficial for women who may experience challenges with MRI due to anxiety, BMI considerations or mobility issues.

As with many cancers, early detection is crucial and can be life-saving. We strongly encourage women aged 40 and over to undergo annual breast screenings. If you have risk factors such as a family history of breast cancer, previous radiation exposure or genetic mutations like BRCA1 and BRCA2, contact your primary care doctor, gynecologist or breast specialist to see if you need to start screening earlier than 40 and/or supplement with additional imaging.

It is my hope that this information empowers women and alleviates some of the anxiety surrounding breast cancer screenings. While some literature regarding breast density may be alarming, I want to emphasize that knowledge is power. Understanding your breast density and being aware of your personal risk factors can facilitate proactive health decisions. Advances in technology, such as those available at LHGV, offer women unprecedented options for early detection. By remaining diligent with regular screenings and utilizing supplemental imaging as necessary, you can take charge of your breast health and significantly enhance your outcomes and in turn, your quality of life.

Janet Yeh, MD, is a breast surgeon at Lenox Health Greenwich Village