Our goal is:
To inform patient of their personal risk of developing breast cancer
To outline personalized risk reduction strategies
To assist women in choosing appropriate screening to supplement yearly mammogram
Q. BREAST DENSITY: WHAT DOES THAT MEAN?
A. Breasts are composed of both fatty tissue and fibro-glandular tissue (see diagram). The degree of density is determined by the mammogram. The more fibro-glandular tissue, the denser the breast. Fatty tissue is basically black on the mammogram and fibro-glandular tissue is white. Breasts are divided into 4 categories based on the proportion of fatty and dense tissue on the mammogram: fatty, scattered fibroglandular, heterogeneously dense, and dense. Women with fatty and scattered fibroglandular breasts do not need additional imaging.
The challenge in dense breasts is detecting small cancers on screening. Cancers typically start as small white spots on the mammogram. The mammograms in women with fatty breasts show mostly a black background, and white spots associated with small breast cancers tend to be obvious. In dense breasts, the background is mostly white making it more difficult to detect a small breast cancer which is mostly white. The challenge of detecting a small cancer in a dense breast has been compared to the difficulty of finding a snowman in a snowstorm.
Q. WHAT SHOULD I KNOW ABOUT NEW BREAST DENSITY LEGISLATION?
A. The California legislation (SB 1538) requires that women are informed if their screening mammogram showed dense breast tissue. For those women with dense breasts on mammogram the law also requires that they are informed that:
There are additional screening options (Breast MRI and Breast Ultrasound) that can detect breast cancers missed on the mammogram, and they should discuss the need for additional screening options with their physicians.
Q. WHY INFORM ME NOW THAT MY BREASTS ARE DENSE, AND WHY WASN’T IT DISCUSSED PREVIOUSLY?
A. Doctors have known for years that mammograms were much better at detecting breast cancers in women with fatty breast (60%) as compared to women with dense breasts. It is only recently that technologies have become readily available to address the issue and the need for additional screening in women with dense breasts.
Q. IF I GET AN ULTRASOUND OR AN MRI, CAN I STOP DOING YEARLY MAMMOGRAMS?
A. No, yearly mammograms are essential for all women forty years and older. It is the only test that will see new calcium deposits which are often the earliest indicators of an evolving breast cancer. Also, the screening mammogram is the only test that has been proven to reduce breast cancer mortality.
Q. WHO IS A CANDIDATE FOR SCREENING MRI?
A. Screening MRI is the screening procedure of choice for very high risk women such as those with strong family histories or who have inherited the gene for breast cancer (BRCA1/2)…See link to Risk Assessment Program.
Q. WHO IS A CANDIDATE OF SCREENING BREAST ULTRASOUND?
A. Any women who has dense breast and does not have a very high risk of developing breast cancer should consider this options.
Q. WHAT ARE THE DRAWBACKS OF SCREENING ULTRASOUND?
A. One of the major drawbacks is costs since costs are typically not covered by insurance companies. A second drawback is that screening Ultrasound can lead to additional testing and even biopsy for what proves to be a non-cancer (benign) condition (also referred to as a false positive biopsy).
Q. WHAT ARE THE BENEFITS OF A SCREENING ULTRASOUND?
A. The screening Ultrasound can detect small and potentially curable breast cancers that are missed on screening mammogram (Although there are no studies that this improvement in detection will result in improved survival, we are convinced that screening women with dense breasts with Ultrasound will save lives and reduce the need for chemotherapy and radiation).
Q. WHAT IS THE COST OF A SCREENING BREAST ULTRASOUND?
A. Our cash price for a screening Ultrasound is $250.00
Q. WILL MY INSURANCE COVER PART OR ALL OF THE COST OF SCREENING ULTRASOUND?
A. No, insurance does not cover any of the cost for screening Ultrasound.
Q. WHAT IS THE COST OF A SCREENING MRI?
A. Our cash price is $950.00, however, unlike screening Ultrasound, insurance companies will cover part or all of the cost of a Breast MRI for high risk women (see link to Risk Assessment Program). For women who have participated in our Risk Assessment Program the cash price of a Breast MRI is $750.00.
Q. DO I NEED A REFERRAL TO GET A SCREENING ULTRASOUND, MRI OR RISK ASSESSMENT PROGRAM?
A. Yes, we must have a referral and a report will be sent to your referring physician.
Q. HOW OFTEN DO WOMEN WITH DENSE BREASTS NEED ADDITIONAL SCREENING?
A. At present, there are no established guidelines to answer this question. Under ideal circumstances, we would recommend yearly Ultrasound for moderate risk women with dense breasts and yearly MRI for very high risk women. Women who want a more detailed personal analysis of risk and screening options should consider participating in our Risk Assessment Program.
Q. WHAT IS THE ROLE OF TOMOSYNTHESIS?
A. Tomosynthesis or 3-D mammography is a new technology that provides a three dimensional image of the breast and has a proven value in reducing the number of call backs for additional views and a reduction in the number of negative biopsies. It is likely to be able to detect some small cancers that were missed on standard mammography, but at present, the ability of Tomosynthesis to detect these small cancers has yet to be defined.
Q. HOW DO I REDUCE MY RISKS FOR DEVELOPING BREAST CANCER:
A. Three basic strategies for risk reduction:
For more details on risk reduction see link to RISK ASSESSMENT PROGRAM.
Women must be informed if their breasts are dense on screening mammograms
Women whose breasts are determined to be dense on screening must be informed that
The legislation concludes that women with dense breasts should discuss risks and screening options with their physicians
Link to new LEGISLATION (SB-1538).
Our Risk Assessment Program provides:
- A personalized risk assessment
- A risk education plan
- An early detection program
- An assessment of appropriate additional screening options such as Ultrasound and MRI
- An application for insurance coverage for MRI in high risk women and a discount price for MRI in women who do not meet criteria for insurance coverage
The program is open to all women who want more information on risk assessment or more information on MRI and Ultrasound screening.