Women should take the time to understand that all breast tissue is not the same. “When we as radiologists evaluate a breast tissue on mammography, we need to describe the amount of breast tissue,” said Dr. Margaret Szabunio, division chief of women’s radiology at UK. This can be summed up with four types. First, there is fatty tissue which is the easiest to read on a mammogram because you can see abnormalities and calcifications or masses present as white dots. “The second type is called scattered fibroglandular densities, which means you have a couple of different densities throughout the breast and sometimes small lesions may be hiding,” said Szabunio. This is not as sensitive as the fatty tissue.
Third, there is heterogeneously dense breast tissue. “At least more than 50 percent of the tissue or whiteness is present on a mammogram so it is difficult to find abnormalities,” said Szabunio. The trouble is that there are white spots throughout and cancer also appears as a white spot. “The last type is extremely dense breast tissue which is more than 75 percent of the breast that you see is fibrous tissue, so those are the least sensitive mammograms because you are easily missing the possible cancers,” said Szabunio.
Women are becoming more familiar with the types of breast tissue. “In some states it has become a law to let the woman know how dense her breasts are,” said Szabunio. The protocol is that the radiologists dictate cases and their reports usually go to the physicians or if the patient is not referred, she gets the report saying her mammogram is normal. Do not skip out on a mammogram because you think your breast tissue may prevent you from getting accurate results. “The only tool that has been proven to decrease mortality due to breast cancer is screening mammography,” said Szabunio.
Other exams like MRI and ultrasound tend to be more of adjunct studies that cannot work on their own because they are unable to show everything. “On an ultrasound, if you do not do a mammogram you will not see calcifications,” said Szabunio. That is just one issue but due to improvements in technology, radiologists have more confidence in outcomes. “We do this so-called breast whole ultrasound which does one to two sweeps and all of the images are generated on a computer and we look through them,” said Szabunio.
The goal is to find breast cancer as early as possible at the lowest clinical stage. “If you find less than one centimeter, you are doing a great justice to the woman as opposed to finding them in very late stages,” said Szabunio. Dense breast tissue is usually genetic. “There is some increase in tissue when you take women who are postmenopausal and they take hormones,” said Szabunio. The disadvantage to dense breast tissue is obviously looking for cancer. “What happens is that if you look at a breast that is dense, your sensitivity of finding cancer is in the 50 percent and if it is a fatty breast, it is like 89 percent,” said Szabunio. When you have dense breasts doctors worry that you may have non-palpable cancers.
The medical community has taken big steps forward in detecting breast cancer. “Tomosynthesis is a new technology, so when you look at the mammogram it is a two-dimensional study that adds a third dimension and it is helpful for the breasts that are dense,” said Szabunio. UK is the first in Kentucky to have that particular technology. By getting screened, women can do something for their health this month.