New Breast Density Notification Information for Patients

Posted on: 06/01/2012

In compliance with new legislation, effective July 1, 2012 in Virginia, Radiology Imaging Associates has made changes in the information we include in our mammography reports. The new law requires all mammography providers in Virginia to include specific information about the patient’s breast tissue density in the mammogram reports sent to the referring physicians and to patients. For uniformity, RIA has implemented the reporting changes in all of the RIA centers, both in Maryland and Virginia.

Patients will see the following four statements about breast density in the results letter they are provided following mammography exams with RIA. The radiologist interpreting their mammogram will check mark one of the density findings based on the review of the mammogram. The new regulations require that we use specific language, including the descriptions of the four types of breast density developed by the American College of Radiology.

Breast Composition / Density Type:
1 - The breast is composed almost entirely of fatty tissue (less than 25% glandular.)
2 - There are scattered fibroglandular densities (approximately 25% - 50% glandular.)
3 - The breast tissue is heterogeneously dense (approximately 51% - 75% glandular tissue,) which could obscure detection of small masses.
4 - The breast tissue is extremely dense (greater than 75% glandular.) This may lower the sensitivity of mammography.

For patients that have density type 3 or 4 checked, they are advised that their mammogram demonstrates dense breast tissue, which can hide cancer or other abnormalities. A report of the mammography results, which contains information about the breast density is sent to the referring physician's office. Patients should contact their physician if they have any questions or concerns about the reporting of breast tissue density.

About Dense Breast Tissue

The intent of the legislation is to make patients aware that dense breast tissue has the potential to obscure and delay the detection of cancerous tissue in the breast. Patients with dense breast tissue are advised to have a discussion with their physicians about the additional risk factor associated with having dense breast tissue. Unfortunately, there is considerable debate and difference of opinion in the medical community on how this information should be used, and on the value of additional testing for patients without current symptoms or problems. Patients are only advised to make individual decisions with their doctor.

The breast is composed of fatty and glandular tissue. The fatty tissue appears dark grey to black on mammograms and the more dense glandular tissue appears grey to white. The radiologist makes a visual estimate on how much glandular (dense) tissue exists compared to fatty tissue. The density of the breast tissue is referred to as “dense” when the amount of the glandular tissue in the breast is 51 - 75%, or greater than 75%, of the total breast tissue composition.

Density can vary greatly from woman to woman, and sometimes it can vary from year to year for individual patients. The reporting of density can also vary slightly from radiologist to radiologist looking at the same study. The reporting of breast tissue density is not an exact science, because the density is visually, and thus subjectively determined by the individual radiologist reading the mammogram.

The effort to make patients more aware of their breast density is new, but the concern with dense breast tissue potentially obscuring disease is not new for radiologists. In recent years however, with the introduction of digital mammography techniques, radiologists are able to view the mammographic images on computer monitors and they have the ability to adjust brightness and contrast of the mammographic image to better visualize subtle differences in the tissue densities. Digital mammography has been a major improvement over the older film type of mammogram images, helping the radiologists to more accurately detect changes in dense breast tissue associated with cancer.

Women with dense breast tissue should continue to be diligent to obtain routine breast exams, talk with their doctor about any changes in their breast, get their annual screening mammogram, and make healthy life choices, as these actions still represent the best approach to minimize risk of breast cancer.For more information, see The ABCs of Breast Density on the Susan G. Komen website at: 

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