What Radiologists Should Know about Breast Density


The American Cancer Society’s guidelines call for annual mammograms for women starting at age 45. While these screenings can increase the odds of successful treatment, early and accurate diagnosis is often made more difficult by the challenges stemming from accurately classifying breast density.

With the increasing conversation around the topic, imaging clinicians and researchers alike are tasked to determine which imaging methods are most effective for dense breasts, and how best to treat patients with higher breast density. To add a layer of complexity, many states have passed laws mandating density notification.

In advance of the SBI ACR Breast Imaging Symposium, here is what radiologists should also consider about assessing and reporting breast density.

Imaging Dense Tissue Can Be More Challenging

Approximately half of the population has dense breasts. When dense breasts are viewed on a traditional mammogram, radiologists may not be able to clearly identify abnormalities. Studies show mammograms may miss more than 50% of cancers present in dense breasts. This can delay detection and necessitate additional imaging.

How dense breasts are depends on the ratio of fatty tissue to glandular and fibrous tissue. There are four categories of density noted in the industry:

  1. Mostly Fatty. Glandular tissue is less than 25%, and the majority of the tissue is fatty tissue.
  2. Scattered Density. 25-50% of the tissue is fibroglandular, distributed throughout the fatty tissue.
  3. Heterogeneously Dense. 51-75% of the tissue is dense, but is distributed throughout the breast, not clustered together.
  4. Extremely Dense. The breast contains over 75% glandular and/or fibrous tissue. 

Since breast density can impact the effectiveness of traditional mammograms, it’s crucial that radiologists are able to consistently identify and classify the level of density.

Imaging methods such as Digital Breast Tomosynthesis (DBT) can improve screening and diagnosis for dense breasts. DBT in particular could help decrease the number of callbacks and improve cancer detection.

The Changing Landscape of Breast Density Reporting

27 states have laws in place for some level of breast density notification. 13 have bills before the state legislature to require it. The remaining states have no legislation enacted or pending.

The difficulty for radiologists is that these standards vary widely. What circumstances trigger notification, how the notification is worded, and follow-up method fluctuate from state to state.

To help radiologists with notification, the American College of Radiology provides sample lay report letters, which have been recently revised to include breast density reporting.

How Change Healthcare Can Help

McKesson Radiology Mammography Plus is an add-on for McKesson Radiology™ (McKesson Technology Solutions is now Change Healthcare) that provides a single viewing and reporting platform for both radiology and mammography. It allows web-enabled access from any workstation to multimodality breast imaging, including DBT.

This platform helps to streamline the process of evaluating breast density and helps radiologists to make better-informed diagnosis.

The Discussion Is Ongoing

Breast density has emerged as a major topic of interest for radiologists, patients, and legislators. As the laws evolve, the need for supplemental imaging, developing best practices for notification, and exploring more comprehensive mammography solutions are all crucial issues to consider.

Radiologists should stay up to speed with the latest research to be best equipped to inform and educate care teams in the imaging department and throughout the health system.

To learn more about how Change Healthcare solutions can help your imaging department, join us at the SBI ACR Breast Imaging Symposium, booth 305 for a custom demo or schedule some time to chat today.

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