Laws mandating that patients be informed about high breast density after mammograms are on the books in six states, and more states are likely to follow, said experts at the American Society of Clinical Oncology's annual meeting in Chicago on Saturday. Victoria Seewaldt, MD, a professor of oncology at Duke University in Durham, N.C., offered clinicians some advice on how to handle three frequently asked questions from patients who've just learned that they have dense breasts, based on guidance from the California Breast Density Information Group.
The patient wants to know if she should continue to get mammograms. Yes, said Dr. Seewaldt, because laws about notification only raise the possibility that further ancillary tests might be warranted; they don't change screening recommendations.
The patient wants to know how having dense breasts affects her breast cancer risk. Dr. Seewaldt advised looking up the mammogram report itself to answer this question. With heterogeneous density, the relative risk is 1.2 compared to average density, or only slightly raised. With extreme density, the relative risk is 2 to 3. Risk also depends on when the finding occurs in the patient's lifetime.
The patient wants to know if she should get more screening because she has dense breasts. Even with dense breasts, Dr. Seewaldt said, additional screening is warranted only in patients with a high lifetime risk for breast cancer (over 20%) or those who have had mantle radiation, among other risk factors. In these patients, guidelines recommend both mammograms and MRI. However, in patients with a low lifetime risk, or below 20%, no additional screening besides mammogram surveillance is necessary. Additional testing should not be based on just density alone, Dr. Seewaldt noted.