00:00What is breast density and why does it matter? Breast density is categorized into four categories
00:06fatty, scattered tissue, heterogeneously dense, or extremely dense. Dense breasts are composed
00:13of more fibrous, connective tissue, and glandular tissue, meaning glands that produce milk and tubes
00:19that carry it to the nipple than fatty tissue. Because fibroglandular tissue and breast masses
00:25both look white on mammographic images, greater breast density makes it more difficult to detect
00:30cancer. Nearly half of all American women are categorized as having dense breasts.
00:36Having dense breasts also increases the risk of getting breast cancer,
00:40though the reason for this is unknown. Because of this, decisions about breast cancer screening
00:45get more complicated. While evidence is clear that regular mammograms save lives,
00:50additional testing such as ultrasound, MRI, or contrast-enhanced mammography may be warranted
00:56for women with dense breasts. What does the new FDA rule say? The FDA now requires specific
01:02language to ensure that all women receive the same accurate, complete, and understandable
01:08breast density information. After a mammogram, women must be informed whether their breasts
01:14are dense or not dense, that having dense breasts increases the risk of breast cancer,
01:20that having dense breasts makes it harder to find breast cancer on mammograms, that for those with
01:26dense breasts, additional imaging tests might help find cancer. They must also be advised to discuss
01:31their individual situation with their health care provider to determine which, if any, additional
01:37screening might be indicated. Why did the FDA issue the new rule? Prior to the federal rule,
01:4338 U.S. states required some form of breast density notification, but some states had no
01:49notification requirements, and among the others there were many inconsistencies that raised
01:54concerns by advocates, including women with dense breasts whose advanced cancer had not been detected
01:59on a mammogram. The FDA standardized the information women must receive. It is written at an eighth
02:06grade reading level and may address racial and literacy level differences in women's knowledge
02:10about breast density and reactions to written notifications. For instance, our research team
02:16found disproportionately more confusion and anxiety among women of color, those with low
02:21literacy, and women for whom English was not their first language. And some women with low literacy
02:27reported decreased future intentions to undergo mammographic screening. What is the value of
02:32additional screening? Standard mammograms use x-rays to produce two-dimensional images of the
02:38breast. A newer type of mammography imaging called tomosynthesis produces 3D images which find more
02:44cancers among women with dense breasts. So, researchers and doctors generally agree that
02:50women with dense breasts should undergo tomosynthesis screening when available.
02:54There is still limited scientific evidence to guide recommendations for supplemental breast
02:58screening beyond standard mammography or tomosynthesis for women with dense breast tissue.
03:04Data shows that supplemental screening with ultrasound, MRI, or contrast-enhanced mammography
03:10may detect additional cancers, but there are no prospective studies confirming that such
03:14additional screening saves more lives. So far, there is no data from randomized clinical trials
03:21showing that supplemental breast MRIs, the most often recommended supplemental screening,
03:26reduce death from breast cancer. However, more early stage, but not late stage, cancers are
03:32found with MRIs, which may require less extensive surgery and less chemotherapy.
03:37Various professional organizations and experts interpret the available data about supplemental
03:42screening differently, arriving at different conclusions and recommendations. An important
03:48consideration is the woman's individual level of risk, since emerging evidence suggests that women
03:53whose personal risk of developing breast cancer is high are most likely to benefit from supplemental
03:59screening. Some organizations have concluded that current evidence is too limited to make
04:04a recommendation for supplemental screening, or they do not recommend routine use of supplemental
04:09screening for women based solely on breast density. Others recommend additional screening
04:14for women with extremely or heterogeneously dense breasts, even when their risk is at the
04:20intermediate level. What should women consider about added screening? Because personal risk of
04:25breast cancer is a crucial consideration in deciding whether to undergo supplemental screening,
04:30women should understand their own risk. The American College of Radiology recommends that
04:35all women undergo risk assessment by age 25. Women and their providers can use risk calculators such
04:42as Tyrakusic, which is free and available online. Women should also understand that breast density
04:48is only one of several risks for breast cancer, and some of the others can be modified. Engaging
04:53in regular physical activity. Maintaining a healthy weight. Limiting alcohol use.
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