Breast Density Report Are Now Added to Mammogram Results

The U.S. Food and Drug Administration (FDA) now requires breast density to be included in mammogram reports. Dense breasts are problematic because they make it more difficult to detect cancer and raise the risk of developing it. In fact, women with extremely dense breasts have four times the risk for breast cancer as women with fatty breasts do, according to Cleveland Clinic.

“This policy went into effect on September 10, 2024, and it’s definitely a step in the right direction,” says Bernard Kaminetsky, MD, medical director, MDVIP. “Recent studies suggest that dense breasts might exceed other breast cancer risk factors such as age, family history, substance use and being overweight.”

What Are Dense Breasts?

Dense breasts are defined as those having fairly high amounts of glandular and fibrous connective tissues and considerably lower amounts of fatty breast tissue. Breasts are comprised of several types of tissue – glandular, fibrous connective and fatty. 

• Glandular tissue is the part of the breast that produces milk. It includes lobules (small glands that produce milk) and ducts (tiny tubes that carry milk from lobules to nipples). 
• Fibrous connective tissue supports, protects and holds muscles and tissue in place. 
• Fatty tissue is fat that fills the spaces between the fibrous connective and glandular tissues.

Fatty tissue looks dark or transparent on a mammogram, whereas glandular tissue, fibrous connective tissue and malignant masses appear as white. This makes it difficult for radiologists to distinguish cancer from healthy tissue, raising the risk for breast cancer to either be overlooked or diagnosed at a later stage. Moreover, dense breast tissue has more cells that can turn from normal to cancerous.

Mammogram Reports

Mammograms are an x-ray of the breast. Studies have shown that mammograms are the most effective method of finding breast cancer early.

American Cancer Society guidelines state that women between 40 and 44 can begin getting annual screening mammograms. However, Johns Hopkins Medicine encourages women to begin around 40, as one in six breast cancers develop in woman ages 40 to 50. Women between 45 and 54 should get a mammogram every year. Once a woman reaches 55, she can continue getting annual mammograms or opt to every two years. Screenings should continue, provided a woman is healthy and expected to live at least another 10 years.

Mammogram results are reported using a standardized system known as BI-RADS (Breast Imaging Reporting Data System). Until recently, BI-RAD scores were limited to seven categories (0 through 6) that described findings ranging from “not cancer” to “high likelihood of cancer”. Now, BI-RAD scores also will include the four density categories, which are defined as:

• Category A – tissue predominantly fatty. About 10 percent of woman fall into this category.
• Category B – tissue is mostly fatty with some scattered denseness. About 40 percent of woman fall into this category.
• Category C – tissue is moderately dense with some fatty tissue. About 40 percent of woman fall into this category. 
• Category D – tissue is predominantly dense; in fact, at least 75 percent of the tissue is dense. About 10 percent of woman fall into this category.

You have little control over your breast density. It’s primarily influenced by genetics, age, family history and menopause status, although weight gain and medications may play a role, according to Johns Hopkins Medicine. However, it’s important to know your category. Women who fall into category D have higher risk of developing interval breast cancer compared to women in the other categories. These women may be prescribed a bi-annual screening routine that may include MRIs, ultrasounds, mammograms and mammograms with contrast.  

“Breast cancer is not considered a preventable disease. This is why it’s important to follow your doctor’s recommended screening schedule. It can help you get diagnosed earlier and improve the chances of a better outcome should you develop cancer,” says Kaminetsky. “Another consideration is a living a healthy lifestyle -- it may lower your risk for a malignancy forming.”

Tips to Help Lower Your Risk for Breast Cancer

Here a few tips recommended by the U.S. Centers for Disease Control and Prevention.

• Manage your weight. 
• Exercise regularly.
• Limit alcohol intake.
• Control inflammation levels.

You also should work closely with your doctor for additional lifestyle tips and to help you stay on your breast cancer screening schedule. If you don’t have a doctor, consider joining an MDVIP-affiliated practice. Click here to learn more about the benefits of the MDVIP personalized care approach and find a doctor near you.