New breast tissue alert requirement begins

Karen Bouffard
The Detroit News

Michigan becomes the 25th state Monday to require that women get more information about their breast cancer risks.

A law signed by Gov. Rick Snyder in January requires that women be notified if their mammogram reveals they have dense breast tissue that can make it more difficult for a radiologist to spot a tumor. Dense tissue may also increase breast cancer risk.

Notification will enable women to be more active about guarding their health, but they shouldn't panic if their breast tissue is dense, experts say. A finding of dense breast tissue does not necessarily mean a woman will get cancer.

Breasts can be predominantly fatty or may have varying degrees of density — and "neither are good or bad," said Dr. Evita Singh, a radiologist and women's imaging sub-specialist with St. John Providence Health System.

Having a lot of dense breast tissue slightly increases a woman's risk of breast cancer, but "it's a minuscule increase of risk", Singh added.

"We've always reported (density) to the physician, but now we're giving that information to the patient who might not be informed on what to do with that," she said. "There are a lot of other things that matter, (such as) family history and environmental issues."

Connecticut became the first state to enact a breast density law at the urging of a patient, Nancy Cappello, who was diagnosed with advanced stage breast cancer in 2004. She had received normal mammography reports for more than a decade; her tumors had been masked by dense breast tissue.

Cappello later became the founder and executive director of Are You Dense Inc., a group that advocates nationwide for notification laws.

According to Singh, a tumor is hard to distinguish from dense breast tissue on mammography images, so it's easy to miss a tumor if the patient has lots of dense tissue.

"The (dense) tissue is like white clouds and the fat is black," she said. "Unfortunately it's hard to find tumors against the white clouds because tumors are also white."

Women who learn they have dense breast tissue should ask their doctors if there is a reason for concern.

"The best thing to do is to touch base with their OBGYN and discuss what they should do next with this information," Singh said. "If they have a strong family history and very dense breasts, they may decide with their physicians to do an MRI (Magnetic resonance imaging) — or if a women just has dense breast, she may want to get a 3-D mammogram at her next yearly exam."

Women's health advocates are working to pass laws, like those in Connecticut and New Jersey, to ensure women have adequate insurance coverage for additional testing if appropriate.

"From my perspective as a physician, the 3-D mammogram has been helping find very small invasive cancers. But Michigan has not provided full coverage of a 3-D mammogram, so our patients are paying out of pocket for that additional charge," Singh said, noting that a handful of Michigan insurers pay for the relatively new technology.

Helen Stojic, spokeswoman for Blue Cross Blue Shield of Michigan, the state's largest health insurer, said a woman should consult her doctor about whether further testing is needed.

"If a physician believes further imaging is medically necessary, we would cover an ultrasound," Stojic said. "If ultrasound is not adequate, documentation from or a discussion with the physician on why ultrasound was not adequate would be needed for MRI coverage."