It's Not All About Breast Density: Risk Matters
Authors: Nancy C. Dolan, Mita Sanghavi Goel
Journal: Annals of Internal Medicine (2015)

Editorials19 May 2015It's Not All About Breast Density: Risk MattersNancy C. Dolan, MD and Mita Sanghavi Goel, MD, MPHNancy C. Dolan, MDFrom Northwestern University Feinberg School of Medicine, Chicago, Illinois.Search for more papers by this author and Mita Sanghavi Goel, MD, MPHFrom Northwestern University Feinberg School of Medicine, Chicago, Illinois.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0821 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Breast density is a prickly topic. Data suggest that dense breast tissue, typically defined radiographically as heterogeneously or extremely dense breasts, confers an increased risk for breast cancer and decreases the sensitivity of mammography (1). While the medical community continues to assess optimal methods of managing breast cancer screening in women with dense breasts, legislative changes have brought this issue to the forefront. Since 2009, in response to grassroots advocacy, at least 21 states have enacted legislation mandating that women with mammographically dense breasts receive information about this finding with their mammography results. The language of the laws varies, with ...References1. Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, et al. Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 2000;92:1081-7. [PMID: 10880551] CrossrefMedlineGoogle Scholar2. American College of Radiology. ACR Statement on Reporting Breast Density in Mammography Reports and Patient Summaries. Reston, VA: American College of Radiology; 2012. Accessed at www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/Statement-on-Reporting-Breast-Density-in-Mammography-Reports-and-Patient-Summaries on 7 April 2015. Google Scholar3. Khong KA, Hargreaves J, Aminololama-Shakeri S, Lindfors KK. Impact of the California breast density law on primary care physicians. J Am Coll Radiol. 2015;12:256-60. [PMID: 25547378] doi:10.1016/j.jacr.2014.09.042 CrossrefMedlineGoogle Scholar4. Kerlikowske K, Zhu W, Tosteson ANA, Sprague BL, Tice JA, Lehman CD, et al. Identifying women with dense breasts at high risk for interval cancer. A cohort study. Ann Intern Med. 2015;162:673-81. doi:10.7326/M14-1465 LinkGoogle Scholar5. American College of Radiology. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). 4th ed. Reston, VA: American College of Radiology; 2003. Google Scholar6. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al; ACRIN 6666 Investigators. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299:2151-63. [PMID: 18477782] doi:10.1001/jama.299.18.2151 CrossrefMedlineGoogle Scholar7. Bolton KC, Mace JL, Vacek PM, Herschorn SD, James TA, Tice JA, et al. Changes in breast cancer risk distribution among Vermont women using screening mammography. J Natl Cancer Inst. 2014;106. [PMID: 24957223] doi:10.093/jnci/dju157 CrossrefMedlineGoogle Scholar8. Sprague BL, Stout NK, Schechter C, vanRavesteyn NT, Cevik M, Alagoz O, et al. Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Ann Intern Med. 2015;162:157-66. [PMID: 25486550] doi:10.7326/M14-0692 LinkGoogle Scholar9. D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013. Google Scholar10. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al; ACRIN 6666 Investigators. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307:1394-404. [PMID: 22474203] doi:10.1001/jama.2012.388 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Northwestern University Feinberg School of Medicine, Chicago, Illinois.Acknowledgment: The authors thank Dr. Judith Wolfman for her assistance with preparing this editorial and ensuring its clarity and accuracy.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0821.Corresponding Author: Nancy C. Dolan, MD, Northwestern University Feinberg School of Medicine, 675 North St. Clare, Suite 18-200, Chicago, IL 60611; e-mail, [email protected]org.Current Author Addresses: Dr. Dolan: Northwestern University Feinberg School of Medicine, 675 North St. Clare, Suite 18-200, Chicago, IL 60611.Dr. Goel: Northwestern University Feinberg School of Medicine, Rubloff Building, 10th Floor, 750 North Lake Shore, Chicago, IL 60611. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIdentifying Women With Dense Breasts at High Risk for Interval Cancer Karla Kerlikowske , Weiwei Zhu , Anna N.A. Tosteson , Brian L. Sprague , Jeffrey A. Tice , Constance D. Lehman , Diana L. Miglioretti , and Identifying Women With Dense Breasts at High Risk for Interval Cancer Karla Kerlikowske , Weiwei Zhu , Anna N.A. Tosteson , Brian L. Sprague , Jeffrey A. Tice , Constance D. Lehman , Diana L. Miglioretti , and Metrics Cited ByRisk factors for an advanced breast cancer diagnosis within 2 years of a negative mammogramPrimary Care Provider Experience with Breast Density Legislation in MassachusettsA web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care systemMRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer 19 May 2015Volume 162, Issue 10Page: 729-730KeywordsBreast cancerBreast cancer screeningCancer screeningInterleukinsLegislationMagnetic resonance imagingMammographyUltrasound imaging ePublished: 19 May 2015 Issue Published: 19 May 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...