By JoAnn Pushkin

In 2013, New York became the very first state to require women be informed of their own breast density after their mammograms.  Unfortunately, my own story of a later-stage missed cancer was the inspiration.  Though faithful to my mammography schedule, my cancer went undetected an estimated 5 years in a row hidden behind dense tissue. I discovered it during a self-exam. I was never told I had dense breasts, never told breast density drastically compromises the effectiveness of a mammogram, and, tragically, was never referred on for further screening which would have detected my cancer at an earlier stage.

Astoundingly, on the day my lump was so big I could feel it, it did not show up on a mammogram; it did, though, display clearly on an ultrasound.  Since then I have devoted time to enacting legislation which requires women be provided information about their own breast density, and launch of a medically sourced, educational website DenseBreast-info.org.   My goal is to prevent my tragedy from taking a seat at anyone else’s kitchen table.  Below I share what I wish I had known before my cancer diagnoses.

 Breast Density Fast Facts:

1. Breast density is determined through a woman’s mammogram and described as one of four categories.
2. Dense breasts are normal. 40% of women age 40 and over have dense breasts.
3. Although normal, dense breast tissue is a risk factor for developing breast cancer and the denser the breast, the greater the risk.
4. Though mammograms pick up some cancers not seen on other screening tests, in dense breasts, cancers can be hidden on mammography and may go undetected until they are larger and more likely to have spread.
5. Other screening tests like ultrasound or MRI, in addition to mammography, substantially increase detection of early stage breast cancer in dense breasts.

In 2017, New York will become the first state to provide full coverage (no copay / no deductible) for mammograms and follow-up breast screening or diagnostic imaging exams.  This law, effective on Jan 1^st, 2017, seeks to remove financial/insurance barriers between a patient and an early stage diagnosis.

Screening After Mammography:

Should you have a regular (2D) digital mammogram or a 3D (tomosynthesis) mammogram?

• 3D mammograms improve the chance of finding cancer in most breasts, but are less helpful for women with extremely dense breast tissue. 3D mammograms also reduce the chance of being called back for additional imaging for a finding that turns out not to be cancer.

Who should have screening ultrasound?

• Ultrasound screening is appropriate every year in addition to mammography for women with extremely dense breasts.

• Women who have heterogeneously dense breasts, and especially those who have other risk factors, should consider screening with ultrasound in addition to mammography if they are not having an MRI.

What about breast MRI?

• In addition to routine yearly mammography, women who are at high risk for breast cancer because of known disease-causing genetic variations, prior chest radiation therapy, or who have a strong family history of breast cancer should have screening MRI. If you have screening MRI, there is no added benefit from screening ultrasound.

For more information about breast density, personal risk factors and what screening tools may be right for you, visit the For Patients tab at DenseBreast-info.org. There is a printable Breast Cancer Risk Checklist to complete and discuss with your health care provider and an easy to follow patient table, Is My Mammogram Enough?

© 2016 JoAnn Pushkin and DenseBreast-info, Inc.,

JoAnn Pushkin is Executive Director of educational website DenseBreast-info.org and cofounder of the advocacy group DENSE (Density Education National Survivors’ Effort).