The Myth of the Normal Mammogram

Women have been told for years to get their yearly mammogram. And, this is good, because indeed mammograms do save lives! However, when women receive results of a normal mammogram, they in many instances are unaware of a critical factor which may be undermining the accuracy of their mammogram. This critical factor is breast density. If you look at your mammogram, the areas that show up “white” on the mammogram are the dense areas. The more “white” you have on a mammogram, the more dense your breast tissue. And, the more dense your breast tissue, the less accurate the mammogram becomes in detecting a possible breast cancer.

Recent studies have shown that in the presence of dense breast tissue, the sensitivity (or ability of a mammogram to detect cancer) of mammography plummets to 30-50%! In other words, for every 1 cancer that is detected, there is 1 that goes undetected. This is an alarming statistic. However, more alarming is that most women are not informed of their breast tissue density after having a mammogram. This has led to a national movement in breast density legislation which aims to make mandatory reporting of breast density to women having a mammogram. This movement began in Connecticut and is well underway in many other states through the efforts of the “Are You Dense?” organization.

The great news is that there is a solution to this problem. Advanced breast imaging studies, including breast MRI, breast ultrasound, and breast nuclear medicine imaging (PEM=positron emission mammography & BSGI=breast specific gamma imaging) all have shown to be much more accurate for the detection of breast cancer in women with dense breast tissue. Of the three, MRI is the most sensitive but the most expensive and the hardest for which to get insurance authorization. MRI has the added benefit of having no radiation. The nuclear medicine studies do come with a fairly high radiation dose when compared to a mammogram. And although ultrasound is readily available at many centers, the results of the ultrasound are highly dependent upon the person performing the exam. I highly urge all women to know their breast density. It can be found by simply obtaining a copy of your mammogram report. If you happen to have dense breast tissue, then you should try to supplement your annual mammogram with an advanced imaging technology that can better “see through” dense breast tissue. MRI is the preferred choice. However, if you are unable to get a breast MRI, there are alternative technologies to consider. And, if you do decide to undergo a breast MRI, make sure you go to an experienced center. Some things to ask yourself when selecting this place:

(1) Does the center have a dedicated breast MRI machine such as the Aurora breast MRI system?

(2) Does the center have a specialized breast radiologist to interpret the exam?

(3) Does the center have the capability to perform breast MRI biopsy?

(4) Does the center have accreditation in breast MRI?

Published by Dr. Thomas Bakondy, Breast Radiologist

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