Why Your Mammogram Results May Soon Look Different

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Key Takeaways

  • The Food and Drug Administration (FDA) has updated its guidelines, asking mammography centers to give patients information about the density of their breast tissue.
  • In the United States, 38 states already have laws requiring that patients are told about their breast density.
  • The new requirement provides specific language for describing breast density and what it means.
  • Having dense breast tissue makes cancer harder to detect by a mammogram and is also a risk factor for developing breast cancer.

The Food and Drug Administration (FDA) will now require mammography centers to notify patients if their mammograms show that they have dense breast tissue. The new requirement is an update to the Mammography Quality Standards Act (MQSA) of 1992, which was put in place to ensure that facilities that do mammograms provide quality care.

Experts say that breast density matters because a cancerous tumor in a dense breast may not show up as clearly on mammography as it would in a less dense breast. Research shows that for women with very dense breasts, screening mammograms may miss cancer up to half the time.

Under the updated rule, patients will also need to be told what it means to have dense breasts, including how this can affect the accuracy of their mammograms and their risk of getting breast cancer.

Here’s what experts want you to know about the updated guidelines and what it means if you find out you have dense breasts.

Why Mammogram Guidelines Are Changing Now

In the United States, 38 states and the District of Columbia have passed legislation that requires mammography centers to inform patients about dense breast tissue and its consequences.

Since some states still have no requirement, there has been growing inequity regarding the information that patients in different stages get about their mammogram findings.

The FDA’s update will make the requirements more uniform and ideally help address some of these inequities.

“Until now, there has been a patchwork of different laws and requirements with 38 states plus DC requiring variable information be provided to women,” Wendie Berg, MD, PhD, a professor of radiology at the University of Pittsburgh School of Medicine, told Verywell.

The new rule means that organizations like the American Cancer Society (ACS), the American College of Radiology (ACR), the Centers for Disease Control and Prevention (CDC), and others “can work off the same script” when they’re talking to patients, Robert Smith, PhD, senior vice president of cancer screening for the ACS, told Verywell.

Mammography facilities will have to comply with the new reporting requirements by September 2024.

What Your Doctor Will Tell You After a Mammogram

Having dense breasts is not uncommon or necessarily abnormal or “bad”—but it’s only been fairly recently that researchers have started to understand how breast density can complicate breast cancer risk and screening.

While this information is typically noted by the radiologist who looks at the mammogram, a patient’s regular provider may or may not bring it up when they go over the results.

“A woman’s breast density category has usually been included in the report that goes to her doctor,” said Berg. “Unfortunately, many health care providers themselves lack a detailed understanding of the risks of dense breasts.”

Berg said that with the new guidelines, “all women will be told dense tissue can hide cancer on a mammogram and that it increases the risk of developing breast cancer.”

This information is key to making sure that patients have information about their health so they can make informed decisions about their care. To that end, the new requirement will also make sure that patients with dense breasts understand that they might need other imaging tests to look for cancer.

“All women should discuss their risk factors with their healthcare provider,” said Berg, adding that an MRI is the “gold standard” for finding early breast cancer.

People who have dense breasts and other breast risk factors like a family or personal history of breast cancer or an atypical breast biopsy, should talk with their providers about having a screening MRI or a breast ultrasound on top of their annual screening mammogram.

What Does Breast Density Mean?

According to Smith, breast density cannot be determined with a physical exam of the breasts, and “mammographic density does not correlate well with how solid or firm your breasts are.”

Human breasts are made up of glandular tissue, fibrous connective tissue, and fatty tissue. On a mammogram, glandular and connective tissue looks white, and fat shows up as black.

The ACR created four categories of breast density. About 80% of women fall into categories 2 and 3, 10% fall into the least dense category (1), and 10% fall into the densest category (4).

According to the National Cancer Institute, breast density can be noted on a patient’s report in the following ways:

  1. The breasts are almost entirely fatty. The breasts are made up almost entirely of fat.
  2. There are scattered areas of fibroglandular density. There are scattered areas of density made up of connective tissue and glandular tissue
  3.  The breasts are heterogeneously dense, which may obscure small masses. There are many areas of dense glandular and connective tissues.
  4. The breasts are extremely dense, which lowers the sensitivity of mammography. The breasts are almost completely dense with glandular and fibrous connective tissue.

What This Means For You

A new rule by the FDA will help make sure that patients are told if their mammogram shows that they have dense breasts. This information is important to know because breast density can affect mammogram results as well as a person’s risk for breast cancer.


By Valerie DeBenedette

Valerie DeBenedette has over 30 years’ experience writing about health and medicine. She is the former managing editor of Drug Topics magazine.

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