After a mammogram, no one wants to hear the words, “We found a spot on the image.” But it can be a problem for women with high density breast tissue – and it may or may not have to do with breast cancer.
Interview Highlights: Dr. Elizabeth Jekot, director of the Elizabeth Jekot Breast Imaging Center as part of Baylor Scott & White Medical Center – Plano.
Why does high breast density create problems with mammograms? "Breast density is something that is determined by a radiologist when he looks at your mammogram. When we do a mammogram, we only get two colors: We get grey, which is the normal fat. And we get white, which is the normal tissue – tissue meaning the glandular elements and the structural elements. If a woman’s breast is mostly grey, we call them fatty. If it’s mostly white, we call them dense. Now that creates a problem because what we’re looking for are things that are white. We’re looking for white lumps or bumps, and little white dots called micro calcifications, and we look for distortion. If a woman’s breast is more white, it makes it more difficult to discern things. If we’re looking for white things, it’s kind of like looking for a white balloon in a white cloud. There’s very little differentiation. That’s why fat is our friend in the breast. If you’re fatty, we have a grey background and then it is easier to see white things. But if you have a white background, then it makes it difficult to see white things, which decreases the sensitivity for those women who have dense breast tissue."
In this day and age of advanced technology, how is that presenting a problem? “Right now, screening mammography is our number one screening tool. But it’s not perfect. So that’s why we’re looking to alternative measures. One of things we’re employing at our center is something called automated breast ultrasound or 3-D ultrasound. The technologist is able to take and capture up to a thousand images for the radiologist to review at the workstation, which allows us to assess the breast three dimensions. And unlike the mammogram, this allows to evaluate for solid masses that might be hiding in that dense breast tissue.”
Does breast tissue have anything to do with risk for breast cancer? “Unfortunately, even though the mammogram is less sensitive for those patients, those patients with higher breast density have a higher risk for breast cancer. It makes sense to me that if you’re breasts are fatty it has less glandular elements. It has less tissue that is predisposed to developing the actual breast cancer itself, less ductile tissue.”
Why does breast density vary from woman to woman? “A lot of it is your genetic makeup. It’s sort of how you’re put together. Some women have a tendency to be more dense than others. As we grow older, generally speaking, the breasts do tend to become a little bit fattier, but there are some ladies who are mature who still have dense breast tissue.”
Is a mammogram often the first way a woman discovers she has dense breast tissue? “That would be the only way she could find out. But for those patients to know that you are at higher risk based on your density, that’s the time why might want to entertain supplemental screening. Now one of the reasons this has come to light in Texas is in 2011, there was a law passed called Henda’s Law. This law lets all patients know, based on their recent mammogram in a letter they receive from their imaging center, whether or not they have dense breast tissue. So, technically, it’s a law when you have a mammogram here in Texas, to know whether you have dense breast tissue when you get your letter telling you you’re results are normal. The law suggests you visit with your physician about what other supplemental screenings you might entertain.”