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The New Mammogram Frontier

Categories: Women's Health

Imagine being told that the gold-standard technology that millions of women depend on to detect breast cancer may not work for you.

For most young women, as well as a subset of older women, this scenario played out March 1 when a new California law went into effect requiring radiologists to inform women if they have “dense breasts.”

Breast density is not based on family history and cannot be determined by the look and feel of the breast. About 75 percent of women in their 40s have dense breasts. This percentage typically decreases with age; however, even some elderly women continue to have dense breasts. About 40 percent of the 50,000 women Hoag Breast Center screens each year have radiographically dense breast tissue.

The significance of dense breast tissue is that it can hide an underlying cancer on a conventional mammogram or, conversely, mimic a cancer when none exists.
Compounding this problem, women with dense breast tissue are actually at a higher risk for developing breast cancer.

So what do you do if you are told you have dense breasts?

Mammography remains the gold standard for early detection of breast cancer, and all women 40 and older are encouraged to have an annual mammogram.

For those women found to have dense breast tissue, two new advanced complementary breast screening technologies are available at Hoag Breast Center:

Digital breast tomosynthesis: This is a 3D mammogram that was specifically designed to address the limitations of conventional 2D mammography in dense breasts. Hoag was one of only 11 sites selected in the United States to participate in an initial clinical trial of tomosynthesis. Their breast radiologists are considered nationwide experts, and Hoag remains one of only a few breast centers in Southern California to offer the 3D mammogram. Clinical trials published demonstrated that breast tomosynthesis (3D mammography) is significantly better than a conventional 2D mammogram at finding breast cancer, especially in women with dense breasts.

Automated whole breast ultrasound: We've just put the finishing touches on a new suite at Hoag Breast Center that will offer this ultrasound, a new technology that, like breast tomosynthesis, can find cancers hidden within dense breast tissue. Ultrasound relies on sound waves to create an image of the breast. When used in conjunction with mammography, studies have shown that ultrasound can find tumors missed by conventional 2D mammography alone.

October is Breast Cancer Awareness Month, the time of year when radiologists like me tout the virtues of the annual mammogram, and I am definitely here to join the chorus: Early detection saves lives.

Deaths from breast cancer have dropped more than 30 percent since 1990 and most of this reduction has been attributed to mammographic screening. So please don't skip your annual mammogram.

If you are informed that you have dense breast tissue, don't panic. Speak to your physician about 3D mammography and automated whole breast ultrasound. One or both of these new technologies may be right for you.

– Dr. Gary M. Levine is the director of breast imaging at Hoag Breast Center and associate clinical professor at USC Keck School of Medicine. He is the president of the National Consortium of Breast Centers.

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