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LA Times Stirs Breast-Density Debate

June 28, 2010
Written by: , Filed in: Breast Imaging, Diagnostic Imaging, Medical Ethics
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An article in the Los Angeles Times last week discusses “the greatest cancer risk you’ve never heard of”—breast density. It suggests that health-care professionals should routinely tell women how dense their breasts are.

The article, by Karen Ravn (who writes frequently on health topics), says: “Evidence shows that for women with extremely dense breasts, the cancer risk can be four to six times higher than for women whose breasts are not dense. By comparison, a family history of breast cancer—long considered an important risk factor—usually only doubles the risk.”

Despite that, according to the article, “‘Most women don’t even know their own breast density,’ says William Barlow, a senior biostatistician at Cancer Research and Biostatistics in Seattle.”

The article mentions that breast density is usually measured and recorded as part of mammography screening, but primarily for the information of radiologists, because denser breasts make it harder to read a mammogram. And, the article says, many health professionals discourage telling women about their breast density, fearing it will confuse or worry patients for no good reason because women have little control over the density of their breasts.

Barlow disagrees, saying, “I think patients should be told as much information as possible—recognizing they may not be able to use all of it. It certainly should be available if women ask for it. After all, you can’t change most of the risk factors for breast cancer.”

The trend seems to be in favor of more disclosure. For example, a new law passed in Connecticut last year requires, as of October 1, 2009, that all mammography reports to patients include information about breast density based on the American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS).

The article points out that women can use breast-density information in a variety of ways. They may choose to be screened for breast cancer more frequently, or to be screened via MRI, which is more expensive than traditional mammography but does not have the same readability problem with dense breasts. Breast density can also be affected by medications, including hormone replacement drugs (which, studies have found, increase breast density) and the cancer drug tamoxifen (which has been shown to reduce breast density).

The article quotes Norman F. Boyd, MD, senior scientist at The Campbell Family Institute for Breast Cancer Research at the Ontario Cancer Institute in Toronto, as saying: “Theoretically, in the same way that people now take drugs to lower their cholesterol and thus their risk of heart attack or stroke, you could someday take a drug to lower your breast density—and thus your risk of breast cancer.”

Related seminar: Women’s and Breast Imaging

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