By SHANNON MOLTER
What is your breast density? Finding the answer to this question could potentially save your life.
Nancy Cappello, from Woodbury, Connecticut, went for her yearly mammograms and each came back normal.
After an ultrasound appointment in 2003, a 2 1/2 centimeter tumor was found. Cappello was diagnosed with stage 3 breast cancer.
Cappello had dense breasts, which hid the cancer in her mammogram scans behind the tissue.
Nearly half of all women in the United States have dense breast tissue. Women with dense breasts are four to six times more likely to develop breast cancer, according to George Washington University Hospital.
The tumor was discovered in Cappello shortly after she received “normal” results for her annual mammogram.
During a gynecological exam, her gynecologist found a thickening in her breast and sent her for another mammogram and a diagnostic ultrasound. The ultrasound revealed the tumor had by this time metastasized and invaded her lymph nodes.
“I was shocked that my cancer was found so late, not shocked that I had breast cancer,” Cappello said. “I couldn’t wrap my head around it because
I had yearly mammograms that came back as normal.”
A mammography machine can miss cancer in a dense breast because the breast tissue is made of less fat and more connective tissue. Both connective tissue and tumors appear white in a mammography scan. Cancer becomes hidden behind the dense tissue in the screenings.
After the stage 3 diagnosis, Cappello’s doctor revealed what Cappello calls “the best-kept secret:” Her doctor told her that for women with dense breast tissue, it is very hard for the mammogram to see through this dense tissue to find cancer.
Cappello researched her situation and found that it was not unique. There was already about a decade worth of data about the risk of dense breast tissue.
“What really scared me is that my doctors knew about this and never alerted me,” Cappello said. “Maybe my cancer couldn’t have been prevented, but my late stage detection could have.”
She went to her multiple doctors with the research she had found. She asked them if they were informing their patients of their breast density.
“Every one of my doctors said that they do not inform their patients, and they refused to do so,” Cappello said. Some physicians resist the notion of informing patients of their breast density because it is a multifaceted topic. Procedure reimbursement, staffing issues and frightening women regarding cancer risks are reasons physicians refrain from informing women of their breast density, according to the Medscape website.
Fewer than one in 10 women learn about their dense breast tissue from doctors, according to Are You Dense, Inc., a nonprofit organization Cappello founded, while battling her own cancer to inform women about the issue of breast density.
Cappello turned to her state legislature in Connecticut to get a law passed to make it mandatory for physicians to inform women of their breast density after every mammogram. In 2009, the first breast density inform bill in the nation was passed in Connecticut.
“To my amazement, women contacted me from all over the country with personal stories involving breast density, and wanted to get legislation passed in their states,” Cappello said.
This is how the Breast Density Inform Movement began. Fifteen states have the breast density inform law now, and 11 states have introduced legislation.
Wisconsin is not one of these states.
If you have dense breasts, mammography could fail to find cancer. There are options for additional imaging such as ultrasounds or MRIs. An emerging technology for imaging dense breasts is the automated breast ultrasound system from manufacturers such as GE Healthcare, Siemens and SonoCiné.
GE Healthcare, headquartered in Wauwatosa, Wisconsin, is on the forefront of providing this technology to healthcare providers. GE Healthcare has developed an ABUS machine built specifically for breast screening as a followup to a mammogram. It is the only FDAapproved ABUS system for dense breast screening.
“Since the dense tissue causes a challenge for screening technologies, GE Healthcare has been evaluating different technologies since 2001,” said Kristin Bravo, ABUS marketing manager at GE Healthcare. “The ABUS system provides a comfortable exam for patients, does not use radiation and provides radiologists a different perspective of the breast tissue than mammography. Tissue appears white and cancer appears black on an ABUS image, helping make cancer more visible.”
“U-Systems conducted a clinical trial where they screened over 15,000 women with dense breast tissue and performed a reader’s study where the radiologist read the mammograms alone, and then the mammograms followed by an ABUS scan,” Bravo said. “In that study they found that they missed a lot of the cancer when reading the mammogram alone, but when they added the ABUS, they found 35.7 percent more cancer.”
ABUS machines have a large scanning area specifically designed for breast screening. It can quickly capture images of the entire volume of the breast.
“Because of the density inform legislation, there is becoming more and more of a demand for supplemental screening after a mammogram, and the ABUS technology provides them with the tools to meet the demand,” Bravo said.
Northwest Community Hospital, located in Arlington Heights, Illinois, specializes in breast imaging. The hospital implemented the ABUS technology in May 2013.
“We like the ABUS machine because it literally removes the clouds that are seen on a regular imaging mammogram to evaluate a dense breast at a different level,” said Kathleen Quinlin, director of GI services at Northwest Community Hospital. “We’ve had a really good response from patients about the ABUS screenings. About 80 patients have had ABUS screenings every month and only one patient has complained of discomfort.”
As of Jan. 1, 2014, Illinois law requires health facilities that provide mammograms to inform women if they have dense breasts.
“Without the density inform law being introduced, I don’t know if we would have been able to begin the ABUS unit at our facility … it helped with the steps to develop the program,” Quinlin said.
Without a density inform law in Wisconsin, physicians are not required to tell you if you have dense breast tissue.
“Women [in Wisconsin] should have yearly mammograms, find out from their physicians what their breast tissue composition is, ask for their real reports, not their ‘happy grams,’ and have real conversations with their doctors about whether just a mammogram is enough,” Cappello said.