How often do you find that women are not told they have dense breasts by their ob/gyn and therefore do not take this into consideration for testing?

In other words, if a women is not told this, how is she to know that she may need ultrasound in addition to a mamo

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amooremd (Physician - Radiology (Verified) ) - 09 / 22 / 2011

Very often, which is why we decided to tell the patients ourselves..

DrAttai (Physician - Surgery - Breast (Verified) ) - 09 / 24 / 2011

Dense breast tissue causes 2 problems - one is that it is now known that women with dense breast tissue have a higher rate of developing breast cancer, and the second is that breast cancer is harder to detect in women with dense breast tissue. Mammograms will miss 10-20% of breast cancers, more often in women with dense breast tissue. Ultrasound and MRI examinations can be performed in addition to a mammogram, but no test is 100% sensitive and specific for diagnosing breast cancer. Ultrasound and MRI are also more difficult to interpret in women with dense breast tissue, just like mammograms. MRI in particular also has a relatively high (up to 20%) false positive rate - it will often show things that look suspicious and require further investigation and sometimes biopsy, and the finding then turns out to be normal - these are some of the reasons that MRI is not recommended as a general screening test for all women, but rather is recommended for use in specific situations.

I do feel that women should know their breast density - "lumpiness" on exam is not the same as dense breast tissue. This information is generally included in the formal mammogram report provided to the ordering physician, but is not required to be included in the "lay letter" - the letter that gets sent to the patient (the wording of the reports and the lay letter is regulated by the FDA under the Mammography Quality Standards Act:http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm#s9004

Connecticut and Rhode Island have passed legislation requiring that the patient be informed of her breast density, and this is pending in California as well.

There are no uniform recommendations for how to provide increased screening to women with dense breast tissue, but at the very least, make sure that when you get your mammogram, you get a newer digital mammogram, rather than an older, film-screen - you just need to ask the facility and they will let you know. The use of ultrasound and MRI should be discussed with your physician or breast specialist and will take into account your family history and other breast cancer risk factors as well as breast density.
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member3080 (Survivor (1 year)) - 09 / 25 / 2011

As usual, Dr. Attai you have a great answer. Question: How do we get other states to get on board with legislation requiring the patient to be informed of her breast density? Would you know?

My gynecologist(s)- I've had a number NEVER told me that because I had dense breasts I should have further testing beyond a mammogram, and the ultrasound (my decision to get one) was what picked up the cancer, NOT the mammogram. Obviously this is upsetting because my cancer could have been picked up at stage 1 instead of stage 4. The difference between life and death, literallly.

member4136 (Survivor (2 - 5 years)) - 09 / 23 / 2011

Well even when I was diagnosed with breast cancer I can truthfully tell you no one, no doctor, no radiologist has told me that I have dense breast tissue-I just have figured that one out myself. My mammogram 6 months before breast cancer showed nothing-I later found out that this is not so uncommon with women with dense breast tissue. What doctors should be informing people is that women with dense breast tissue some of these tests won't pick it up. At least inform women of this possibility. Most women think that the mammogram will be the final test that everything possible will show up-we need to stop deceiving women and let them know this possibility upfront.
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