HJAR May/Jun 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2023 59 Stacy Smith-Foley, MD Breast Imaging Specialist The Breast Center at CARTI requirement for notifying women of their breast density. Under the current rules, the FDArequires mammogram facilities to send their patients a letter in layman’s terms with their mammogram results. By September 2024, the FDA will require that facilities take it a step further by including specific language indicating whether a patient’s tis- sue is “dense”or “not dense.”These updated guidelines will standardize the language to explain how breast density may influence a woman’s mammogram and future care decisions. As mammography facilities implement the FDA’s new rule, it’s important to reiter- ate to patients that just because a woman has dense breasts doesn’t mean she will get breast cancer. Instead, it should serve as a conversation starter. If a woman is aware she has dense tissue, she and her health- care provider should discuss her risk and what supplemental imaging, if any, should be done in addition to her mammogram. The open line of communication we foster with our patients is essential to enhance their experiences and outcomes. Educating and empowering women to take control of their breast health is critical to preventing, finding, and treating cancer. n Yara Robertson, MD, FACS, is a board-certified sur- gical oncologist and the medical director of surgery at CARTI. Stacy Smith-Foley, MD, is a board-certified breast imaging specialist at The Breast Center at CARTI. Both are passionate about promoting breast cancer awareness and educating women about their risks. Institutes of Health reports that nearly 50% of women over 40 years old, the age the American Cancer Society recommends women start getting a mammogram, have dense tissue. Yet, contrary to public opinion, breast density cannot be determined by “feel” or palpation. Instead, breast density is deter- mined by a radiologist’s assessment of the percentage of “dense” glandular tissue and “not dense” adipose, or fatty, tissue. Unfortunately, mammographic sensitivity, the ability to detect cancer, decreases with increasing breast density. Both dense tissue and breast cancer appear white on a mam- mogram, making the radiologist’s job — and potential detection — harder. As we often tell our colleagues, in women with dense tissue, “It’s like looking for a snowman in a snowstorm.”This masking effect often leads to cancer being found when it’s larger or in more advanced stages. Having dense breasts is also an indepen- dent risk factor for breast cancer. Peer-re- viewed studies have found that women with the highest breast density are shown to be four to six times more likely to get breast cancer than people with the least dense breasts. Dense tissue may be an even more significant risk factor than breast cancer in a first-degree relative. While the risk decreas- es as dense breast tissue regresses with age, data also shows that the risk of breast cancer is higher in women with persistent dense breasts after menopause. Before the FDA’s announcement in ear- ly March, there was no uniform national ONMarch 9, the U.S. Food and DrugAdmin- istration (FDA) captured the public’s and the medical community’s attention when it published updates to the Mammography Quality Standards Act, commonly known as MQSA. Under the amended regulations, mammogram facilities must begin notifying patients about their breast density within 18 months — a process we have voluntarily fol- lowed at CARTI since we openedThe Breast Center in 2019. The announcement left some wondering, “What’s the big deal about breast density?” As the FDA indicated during its unveiling, the expanded rules are designed to “help in- terpreting physicians better categorize and assess mammograms.” As the FDA stated, knowing a woman’s breast density is criti- cal to preventing, detecting, and treating cancer. Evidence suggests it helps inform care decisions and facilitates more effective communication with patients, particularly their need for further evaluations or repeat mammograms. It may sound straightforward, but we need to reiterate it. Women come in all shapes and sizes, and their breasts are no different. A woman’s breast tissue is made up of fat and glandular tissue, and her breast density is the ratio of these two tissue types. When a woman has more glands and fibrous tissues, the denser her breast tissue will ap- pear on a mammogram. Each woman has a unique pattern of tis- sue on her mammogram, almost like a fin- gerprint. Having dense breast tissue is not only normal — it’s common. The National