Breast Screening Tools for Dense Breasts with Dr. Kathy Schilling

What are my Screening Options if I have dense breasts?   

Kathy Schilling, MD
, Medical Director of the Christine E. Lynn Women's Health & Wellness Institute at Boca Raton Regional Hospital

Mammography uses x-rays to image the breast.  It is recommended as the first line of screening.  It has been studied for decades and has shown a 30% reduction in mortality.   Mammography uses compression and involves radiation to penetrate through breast tissue.  As the density of a breast increases, the sensitivity of the mammogram to ‘see’ cancer decreases.  Having dense breasts is the strongest predictor of cancer being missed by mammography.  Digital mammography performs better in dense breasts than analog mammography.  

Tomosynthesis or 3D mammography is a newer form of x-ray and significantly reduces patient call-backs.  Many facilities have replaced 2D with 3D mammogram as its primary screening.  3D increases detection of invasive cancers over traditional digital mammogram across all densities.  However, it is still limited in detection of cancer in the dense breasts.  Discuss with your health-care providers your breast tissue composition and risk and the addition of adjunct screening to your 3D mammogram.

Ultrasound uses sound waves to image the breast.  It does not emit radiation and may generate false positives (suspicious lesions that are determined to be benign after a biopsy).   Ultrasound is readily available.  Studies for decades have shown a significant increase in invasive cancers detected on otherwise normal mammograms.  In recent years, automated ultrasound has become available.   Automated ultrasound seeks to improve operator dependency of hand-held systems.

Magnetic Resonance Imaging (MRI) uses magnetic field to track lesions where blood is concentrating in the breast.  A contrast agent (gadolinium) is used.  MRI is very sensitive in cancer detection but may generate more false positives.  MRI is generally recommended for women with the highest cancer risk.  A quicker protocol for MRI called FAST or Quick MRI is being researched.  It reduces the test time between 4 and 8 minutes, lowering the cost of the test.

Molecular Breast Imaging (MBI) or Breast Specific Gamma Imaging (BSGI) is mostly used for diagnostic imaging.  It uses a radioactive contrast agent and is highly sensitive in detecting cancer. It generates less false positives.

Contrast Enhanced Spectral Mammography (CESM) is a mammogram that is currently used after an inconclusive or abnormal mammogram.  Iodine based contrast injection is used to show increased blood flow, which may indicate the presence of cancer.


Remember:  Breast Density Legislation does not replace educated conversations between patient and provider about personal screening surveillance. Discuss your breast tissue composition and other risks with your health care providers. Request a copy of your mammography reporting results that is written by the radiologist to your referring health-care provider about YOUR breast imaging results. This report most likely will not be the same report that you receive about your mammography results.  In most instances, your breast tissue composition will be in this report.  You are your best health advocate!

 Download as PDF HERE

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  • Are You Dense? Fact #1:

    Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer.

  • Are You Dense? Fact #2:

    Two-thirds of pre-menopausal women and 1/4 of post menopausal women have dense breast tissue. 

  • Are You Dense? Fact #3:

    Adding more sensitive tests to mammography significantly increase detection of invasive cancers that are small and node negative.

  • Are You Dense? Fact #4:

    American College of Radiology describes women with "Dense Breast Tissue" as having a higher than average risk of Breast Cancer.

  • Are You Dense? Fact #5:

    While a mammogram detects 98% of cancers in women with fatty breasts, it finds only 48% in women with the densest breasts.

  • Are You Dense? Fact #6:

    A woman at average risk and a woman at high risk have an EQUAL chance of having their cancer masked by mammogram.

  • Are You Dense? Fact #7:

    Women with dense breasts who had breast cancer have a four times higher risk of recurrence than women with less-dense breasts.

  • Are You Dense? Fact #8:

    A substantial proportion of Breast Cancer can be attributed to high breast density alone.

  • Are You Dense? Fact #9:

    Cancer turns up five times more often in women with extremely dense breasts than those with the most fatty tissue.

  • Are You Dense? Fact #10

    There are too many women who are unaware of their breast density, believe their “Happy Gram” when it reports no significant findings and are at risk of receiving a later stage cancer diagnosis.