It’s not pretty finding out you have “extremely dense” breasts — because this is a big risk factor for breast cancer; what makes this worse is that a tumor can pass as benign fibrous tissue on a mammogram reading.

A cancer surgeon and a diagnostic radiologist weigh in on extremely dense breasts, mammograms and an advancement in imaging.

Do you have “extremely dense breasts” and have read that this is a risk factor for breast cancer and/or that this situation makes it more difficult for a tumor to be detected by eye on a mammogram?

For this article I consulted with Dr. Steven Standiford, MD, surgical leader in the Cancer Treatment Centers of America Breast Cancer Institute across all five CTCA sites, and Dr. Debora Fineman, MD, a diagnostic radiologist at the Philadelphia CTCA.

“Regarding extremely dense breasts and the risk of breast cancer, the issue is more that extremely dense breasts make it difficult to DETECT cancer mammographically,” says Dr. Fineman.

Imaging for Extremely Dense Breasts

“A fairly recent advancement in mammography, Tomosynthesis, is quite beneficial in evaluating dense breasts, as it enables visualization of the breast in ‘layers,’” says Dr. Fineman.

“Most insurance companies will not cover this as a screening procedure. We do get tomosynthesis coverage for performing diagnostic workups  such as evaluating an abnormal screening mammogram or evaluating a clinical problem.

“Screening tomosynthesis is readily available, with some institutions collecting a nominal out-of-pocket.”

Your gynecologist may order this test for you if it’s available in your health network even if it isn’t covered, so ask about it.

What about the MRI for extremely dense breasts?

Dr. Fineman says that coverage for the cost varies across insurance companies, and that most insurance companies will not pick up the cost for MRI screenings.

“I believe the research has not yet been finalized as to risk stratification and frequency of performing screening MRI evaluations,” adds Dr. Fineman.

Dense (fibrous) breast tissue appears as white on a mammogram. So do tumors. But in addition to this visual issue, it’s true that having more fibrous tissue and less fatty tissue increases a woman’s risk of the cancer.

Just how much of an increase is up for debate. This all begs the question: Why isn’t an MRI screening covered by insurance for patients with dense breasts?

Dr. Standiford has this to say: “I worry about policies mandating coverage of a specific, as yet unproven test – for as yet, MRI has not impacted breast cancer mortality, and the resources could be better utilized in expanding mammography coverage – the impact would be far greater.

“Also, newer technology is on the way, for example higher resolution ultrasound, tomosynthesis mammography and breast CT, which may have more utility in screening dense breasts.”

As a part of Dr. Standiford’s life-long commitment to improving cancer treatment, he has partaken in wide-ranging research and has been awarded grants to study breast and colon cancer.
Dr. Fineman has been in practice for 30+ years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  

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