Women will now be informed about their breast density after a mammogram. What should happen next?

Pushkin went to see her doctor, who felt a lump and ordered her to undergo another mammogram and ultrasound. She was surprised when the technician casually remarked: “Your breasts are dense. This will be a very difficult discovery for us to make.”

And she was shocked when the lump that hadn't been visible on the mammogram actually showed up. As cancer The ultrasound examination revealed a “clear” diagnosis. Mastectomychemotherapy, radiation therapy, follow-up surgery, and complications of chronic lymphedema.

But the incident spurred Pushkin to action, and as part of his campaign, he pushed for new federal regulations requiring mammography labs to inform patients about their breast density.

This new rule is: U.S. Food and Drug AdministrationRevised regulations on mammograms came into effect on Tuesday.

Pushkin sent a letter of notification to the FDA in 2010 after his treatment ended, and later testified as part of the process.

After learning that nearly half of women over 40 have dense breasts, which puts them at higher risk for breast cancer and makes it more likely to remain hidden, she MammographyIt will be more difficult to detect.

She also co-founded an educational nonprofit. Dense Breast Informationand fought for New York State's Breast Density Information Bill, which came into force in 2013. A patchwork of state laws They ask for information to be shared about whether the breasts are dense, but not necessarily whether the patient has dense breasts. Have Dense breasts. Here are just a few of the reasons why the new rules are important.

“At the very least, all women in the United States will have a uniform standard that will tell them whether they have dense or dense breasts,” says Dr. Wendy Berg, a professor of radiology at the University of Pittsburgh School of Medicine and chief scientific adviser to Dense Breast Info.

But what does “dense breasts” actually mean? And what should you do if you find out you have dense breasts? Below you'll find the answers to all your questions about breast density and cancer screening.

What does it mean to have dense breasts?

Breasts are made up of fat and glandular tissue, held together by fibrous tissue. A woman's breasts are “denser” if they have more glandular and fibrous tissue than fatty tissue.

About 50% of women in their 40s have some degree of dense breasts. That means nearly half of women undergoing their first mammogram U.S. Preventive Services Task Force If you don't have the recommended screening at age 40 and then every two years, you risk missing breast cancer through a mammogram.

Berg said breast density is not constant and can change over time, with some breasts becoming less dense after menopause.

While there are actually four categories doctors use to classify breasts — fatty breasts (rare), scattered breasts (most common), heterogeneously dense breasts, and very dense breasts — the new rules require all mammography facilities to provide patients with a standardized notification of either “not dense” or “dense.”

But Berg says the details can be important because very dense breasts are at least four times more likely to cause breast cancer than fatty breasts, so if you're notified that you have dense breasts, it's important to ask for clarification.

You have dense breasts, what do you do?

Although mammography has long been considered the gold standard for detecting breast cancer, “I think it's now widely recognized that mammography is actually a poor screening test for dense breasts,” Berg says. “That's been known for quite some time.”

That's because dense tissue shows up as white on a mammogram, and cancer also shows up as white.

In fact, in cases of very dense breasts, “mammograms will miss about at least half of the cancers in that type of tissue,” she says.

Fortunately, there are some alternatives. They're called 3D mammograms. Digital Breast TomosynthesisUltrasound, like mammography, is somewhat effective but prone to false positives, although the number of false positives decreases with second and third scans once a patient's baseline is established.

Then, an MRI (magnetic resonance imaging) is performed in combination with the intravenous contrast agent gadolinium, which is the most effective dense breast screener and is recommended by the American Cancer Society for women at high risk for breast cancer. Since 2007.

Not only is MRI effective — its dark background “makes most cancers really easy to see,” Berg says — but it's also fairly widely available, making it a good option “if you're willing to have contrast injections and aren't claustrophobic.”

Berg also says that if you receive a notification that you have dense breasts, “if you're educated enough to ask for it.” “All women need to advocate for themselves,” she stresses. “It's very frustrating.”

The importance of breast self-awareness cannot be underestimated, as 40% of breast cancer diagnoses are discovered by women who feel a lump. National Breast Cancer Foundation.

There is hope beginning to appear on the horizon. Contrast mammographyIt uses existing equipment but combines it with an iodine-containing contrast agent of the type used for CT scans.

“It gives you all the information you get from a regular mammogram, but because it shines like a light bulb against a black background, it makes the cancer much more visible,” says Berg, who has spent a decade researching the technology, which has not yet been approved by the FDA for screening. “It's very promising.”

Does my insurance cover breast ultrasounds or MRIs?

of Early detection actionsA bill being introduced in 2022 will ensure that all health insurance plans at the federal level cover screening tests, diagnostic mammograms, breast ultrasounds and MRIs without deductibles or copayments, but until then, there's a patchwork of rules and laws.

the current, 33 states and Washington, D.C. There is some legislation mandating the expansion of breast cancer detection coverage to women with dense breasts and other risk factors, but the laws vary and in some places, for example, only ultrasound screening is covered.

Additionally, most insurers are exempt from state laws, so “even if there is a state law, I don't know if insurance will cover it,” Berg said, noting that most insurers will eventually comply because it's cost-effective.

“Catching cancer early is good for women because it's a lot less treatment, but it's also good for insurance companies because it's less expensive. So from everyone's perspective, there are benefits and advantages to catching cancer early,” she says.

That said, there will almost always be a copayment or deductible, although this will vary depending on the plan.

As an alternative for those who can afford it, Berg notes that some medical centers offer what's known as an abbreviated MRI, which is quicker, provided directly to patients without a prescription, charges a flat fee of around $250 to $600, and still costs $1,000. Improved cancer detection rates than a mammogram.

Finally, while this week's breast density notification rule was an important piece when it comes to early detection, Pushkin said the hard-won victory was bittersweet.

“When I first heard the news, I sat down in my chair and thought, 'My God, it's finally over,'” she said. But then she thought of all the women whose cancer had gone undetected. “This happened on the backs of people who were sick and dying,” she said.

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