Maryland Breast Density Awareness Bill

September 10, 2013

As of October 1, 2013 a new State law will go into effect mandating that mammography providers include a notice in the result letter sent to women undergoing screening mammography. The notice includes generic information about breast tissue density and prompts women to discuss this information with their health care provider.

In order to be in compliance with Maryland legislation, all patients will receive letters that include the following language:

This notice contains the results of your recent mammogram, including information about breast density and ends with paragraph, risk factors, or physical examination. A report of your results was sent to your physician.

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.

The breast is composed of glandular tissue and fatty tissue. While the glandular tissue appears grey to white on mammograms the fatty tissue appears dark grey to black. The radiologist will interpret the mammogram and make a subjective determination of the amount of glandular tissue (white tissue) that is present. In general, there are four categories of breast density:

  • Fatty (< 25% fibroglandular tissue)
  • Scattered fibroglandular densities (25-50% fibroglandular tissue)
  • Heterogeneously dense (25-50% fibroglandular tissue)
  • Extremely dense (> 75% fibroglandular tissue)

Dense breasts are those that have a greater proportion of glandular tissue than fat. It is the last two categories of breast density that are reportable (heterogeneously dense and extremely dense) and represents about 50% of women.

There are many factors that influence breast density including genetics, hormones, weight, menstrual cycle and diet. Furthermore, as women age, the proportion of dense tissue gradually decreases and fatty tissue increases.

According to the U.S. Department of Health and Human Services, breast density is important because women with dense breasts may have a higher risk of developing breast cancer compared to women of the same age without dense tissue. Additionally, dense breast tissue decreases the sensitivity of mammography and makes it harder for breast cancer to be seen because breast cancer and normal fibrogladular tissue both appear white on mammograms.

Images produced by digital mammography and the ability of the radiologist to manipulate these images on high resolution monitors for better viewing is advantageous in detecting cancer, particularly in women who have dense breasts. High-quality screening mammograms with digital mammography and regular clinical breast exams are the most effective ways to detect breast cancer early.

The need for additional screening with MRI and/or Ultrasound in women with dense breasts is controversial. At Seton Imaging Center and Saint Agnes Hospital Comprehensive Breast Center we support a risk-based approach. Women with dense breasts who are concerned about their breast cancer risks should discuss the possibilities of additional screening tests with their referring doctor.

There are many ways women in general and particularly those with dense breast may reduce their risk for breast cancer by:

  • Obtain annual screening mammograms as recommended by the American College of Radiology, American College of Obstetrics and Gynecology & American Cancer Society.
  • Obtain regular clinical breast exams by a health care provider.
  • Making healthy lifestyle choices.

As always, the breast imagers/radiologists at Seton Imaging Center and Saint Agnes Hospital Comprehensive Breast Center will be available to educate women and referring physician’s regarding breast health issues and understanding the new law.

Additional information regarding breast density may be found at:
ACR Breast Density Brochure (PDF)
Susan G. Komen Breast Density Factsheet (PDF)

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