The Katz Institute for Women’s Health (KIWH), a dedicated network of experts devoted to every aspect of women’s care, is putting women first. The below content was originally published in its entirety on the Katz Institute for Women’s Health’s website and exemplifies its commitment to raise health for all women.
Nearly half of all women have “dense breasts”—yet countless don’t find out until later in life. Dense breasts have more fibrous and glandular tissue relative to fat tissue in the breast. Because both breast cancer and this breast tissue appear white on mammograms, mammograms alone can miss up to 60% of cancers in dense breasts.
JoAnn Pushkin, patient advocate and co-founder of DenseBreast-info.org, lived through this exact scenario. “My own cancer was missed for nearly five years in a row,” she says. “During that time, I received a ‘normal’ mammogram report every one of those years. The cancer was present, but because my breasts were so dense, the cancer could not be seen. The day my cancer was big enough to feel, it still did not show up on a mammogram.”
Dense breasts are not something you can see or feel, explains Bonnie Litvack, MD, diagnostic radiologist at Northwell. Density has nothing to do with breast size or firmness. It is genetic, like hair or eye color. Dense breast tissue not only makes mammograms more difficult to read, but it is also a risk factor for breast cancer. Women with dense breasts have a higher risk of developing breast cancer than women who don’t have dense breasts, Litvack says. Density can also vary over a woman’s lifetime, mostly due to hormonal changes, hormone replacement therapy, pregnancy, and breastfeeding. This is why women need access to advanced screening tools in addition to mammograms—and why those tools need to be universally covered by insurance, Litvack and Pushkin say.
On September 10, 2024, the FDA’s rule stating that mammogram reports sent to patients must include breast density, which should be described as either “not dense” or “dense,” took effect. “[The legislation] is a really great thing. We’re happy about this,” Litvack says, but it’s not enough. Once women know they have dense breasts, they need to be able to get additional screening, such as an ultrasound or MRI, to help ensure cancer is caught.
Nationally, insurance coverage for additional screening after a mammogram is inconsistent and can depend on a woman’s insurance policy, her insurer, and state law. Without coverage for supplemental screening, “women are being left out in the cold,” Pushkin says. “Women write to us all the time with insurance questions, often denials of supplemental screening.”
Surprisingly, this gap exists around the country in part because doctors fear more false-positive breast cancer screenings. More screening may include false positives, Pushkin acknowledges, adding “You will never die from a false positive—but you can die from a false negative. It is a small price to pay for the chance to find cancer at the earliest stage possible.”
Women who have dense breasts and/or other risk factors need to have a conversation with their health care clinician about a breast screening protocol that is appropriate for them.
We know supplemental screening can improve women’s chances of detecting cancer early. Physicians and legislators must get over their own fears and ensure women get the mammograms and supplemental screenings they need.
“Information empowers,” Pushkin says. “Give women the information to make the best decisions for themselves.”