Those randomized trials of mammography that reduced the rate of node positive breast cancer AND reduced the rate of advanced disease, reduced deaths. While we can look at the increase in the detection of breast cancers to assess our screening programs, it is not enough unless we see a similar reduction in the late stage diseases.
Research for decades has show that having dense breast tissue is the strongest predictor of the failure of mammography to detect cancers. Tragically, with missed and delayed diagnosis of breast cancer comes a later stage diagnosis often with node metastases, a predictor of poorer survival outcomes.
The authors in this study referenced the density reporting movement, which started in Connecticut in 2009, to disclose dense breast tissue to the patient through the mammography reporting results for shared screening decision making. The authors also concluded "that going forward breast cancer screening programs should embrace the opportunity to tailor imaging to provide the greatest benefit to all women to reduce advanced disease." It is only through a more sensitive screening tool than mammography or multi modal screening will the equality of reliable breast cancer screening to reduce advanced disease and mortality be achieved.
Take Away: Discuss with your doctors and advocate for the opportunity for added screening to your mammography if you have dense breast tissue.
The November, 2014 study from the Breast Journal, Insights from the Breast Cancer Screening Trials: How Screening affects the Natural History of Breast Cancer and Implications for Evaluating Service Screening Programs can be found HERE.
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Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer.
Two-thirds of pre-menopausal women and 1/4 of post menopausal women have dense breast tissue.
Adding more sensitive tests to mammography significantly increase detection of invasive cancers that are small and node negative.
Cancer turns up five times more often in women with extremely dense breasts than those with the most fatty tissue.
While a mammogram detects 98% of cancers in women with fatty breasts, it finds only 48% in women with the densest breasts.
A woman at average risk and a woman at high risk have an EQUAL chance of having their cancer masked by mammogram.
Women with dense breasts who had breast cancer have a four times higher risk of recurrence than women with less-dense breasts.
A substantial proportion of Breast Cancer can be attributed to high breast density alone.
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.