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New Front Opens In Mammogram Wars: Density

August 24, 2012
Written by: , Filed in: Breast Imaging, Medical Ethics
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A side battle in the mammography wars erupted this week over breast density.

On Monday, the Journal of the National Cancer Institute published online a study of women with dense breasts. Greater breast density has been established as a risk factor for breast cancer, but the study’s authors wanted to know whether it also made such cancers more deadly.

The study concluded that it did not:

It is reassuring that elevated breast density, a prevalent and strong breast cancer risk factor, was not associated with risk of breast cancer death or death from any cause in this large, retrospective study.

That same day, a USA Today article about the study strayed onto the topic of laws requiring that women be informed if their mammograms show they have dense breasts. The story quoted Barbara Monsees, MD, co-chair of the American College of Radiology’s breast imaging committee, as calling such laws well-intentioned but possibly premature.

Also on Monday, the ACR and the Society of Breast Imaging released a statement about the new study. It advised caution and careful scientific research about whether women with dense breasts should routinely undergo supplemental breast cancer screening with MRI or ultrasound.

The reasons will be familiar to anyone who has followed the debate over mammography: The supplemental screening methods lead to more false positives than mammography. False positives lead to unnecessary anxiety, biopsies, expense, and sometimes even surgery. Women at high risk for breast cancer should have supplemental screening with MRI, but more research is needed about the efficacy of supplemental screening for the general population.

Are You Dense, an advocacy group for women with dense breasts, responded, in essence, “Are you nuts?” On Tuesday, it posted a response to what it called the “misinformation” from the ACR and SBI.

Are You Dense disagreed with Dr. Monsees’ interpretation of the scientific research and contended that women with dense breasts deserve to be informed of that fact:

The goal of Breast Density Inform legislation is to give women a powerful tool—information. With knowledge of one’s own breast density, a woman can be more aware of changes in her breasts that merit evaluation beyond a mammogram.

Are You Dense also pointed out that the new study found that “once a women with dense breast tissue is in treatment, she is no more likely to die than anyone else at her stage.” The problem, the group said, is that dense breast tissue can cause a woman to be diagnosed at a later, less-treatable stage than someone with less-dense tissue. Therefore, in reality, she does have a greater risk of death.

All in all, the week shed a little more light on the risks of dense breasts and generated a lot more heat.

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