When Emmy-award-winning actress Julia Louis-Dreyfus was diagnosed with breast cancer recently, she announced that “One in eight women get breast cancer. Today, I’m the one.”
This is one of several startling statistics regarding breast cancer. And though women are scheduling mammograms this October during Breast Cancer Awareness Month, many patients aren’t aware of the risks associated with having dense breast tissue.
More than 40 percent of women age 40 and older are estimated to have dense breasts. According to the Journal of the National Cancer Institute, women with dense breast tissue are four to five times more likely to get breast cancer than women who do not.
In addition, women with dense breasts are more likely to have mothers and grandmothers with dense breasts, as cited in MedicalNewsToday.
DailyNorthShore asked Georgia Giakoumis Spear, MD, a radiologist specializing in breast imaging at NorthShore University HealthSystem, to talk about the study she’s leading on a relatively new technology that’s identifying previously hard-to-find cancers in women with dense breast tissue.
DNS: What is dense breast tissue, and how does a patient know she has it?
Dr. Georgia Giakoumis Spear: Dense breast tissue means that a woman, as seen on the mammogram, has more fibroglandular breast tissue than fatty tissue in her breasts. Dense breast tissue on a mammogram appears as white and it can hide or mask breast cancer. Almost half of women screened at NorthShore have this tissue type, and we know that we can miss up to one-third of breast cancers if a woman has dense breast tissue.
Furthermore, dense breast tissue carries an intrinsic increase in breast cancer risk, so the more fibroglandular breast tissue a woman has, the more elevated her risk is for developing breast cancer. It’s important for us to know what a women’s tissue type is, and to educate her. Our goal in breast imaging is to detect breast cancer early when it’s treatable. We screen women annually starting at the age of 40.
DNS: Please explain the new technology for detecting dense breast tissue.
Dr. Spear: For many years as breast imagers, it’s been a conundrum for us to detect breast cancer in women with this tissue type. We can detect a lot of them, but not all. It’s fascinating that there are emerging technologies assisting us with looking through that tissue better, so it can increase our ability to detect breast cancer early to help save more lives.
At NorthShore we’re one of the earliest adopters in the country who have a program where we offer Automated Whole Breast Ultrasound (ABUS) as a supplemental screening tool for women with dense breast tissue. NorthShore adopted this technology in November of 2015, and we’ve been using it for about two years to overcome the masking effect of dense tissue on mammography. Another reason is that women are demanding it. There’s federal and state legislation in about 29 states now, which is really educating women who know about their dense breast tissue.
The legislation is trying to increase the pathway of communications between doctors and patients to inform them about their tissue type, the risks involved, and what tools are available.
DNS: How new is the ABUS?
Dr. Spear: There were variations of this tool that have been around for years, but the image quality and the sensitivity of the test to help us detect abnormalities has been largely improved in the last two years. The particular ABUS that we have at NorthShore was FDA approved in 2012, and any new test takes several years to investigate and clinically apply. We adopted it in 2015, and the early results that we’re gathering are extremely promising. It helps with our callback rate, by not creating such a high false-positive group. ABUS gives women more reassurance.
More importantly, a screening mammogram is the gold standard, and by no means is ABUS to replace screening mammography. Combining both technologies together allows us to find more cancers that we weren’t seeing, and it’s an added benefit.
DNS: Do you recommend MRIs for patients with high density breast tissue?
Dr. Spear: We use MRIs for women who are at higher risk for developing breast cancer. If a woman has a lifetime risk that is greater than or equal to 20 percent, an MRI is appropriate as an additional tool, and the reason is that we need to balance the specificity of the exam to detect breast cancer and the false-positive rate that is associated with that exam.
High-risk women make up a much smaller portion of the population than women who are at average or slightly higher than average risk.
DNS: In cases with family histories of breast cancer, do you recommend having a mammogram before the age of 40?
Dr. Spear: We follow the American College of Radiology guidelines that recommend annual screenings at the age of 40. But we can detect which women fall into the high-risk category from their medical histories. For example, if a patient notifies her doctor that her mom, sister or another close relative was diagnosed with pre-menopausal breast cancer, then the patient might be a candidate for genetic screening. If a woman has the risk that she may either carry a breast cancer gene or has a lifetime risk that is greater than or equal to 20 percent, then she could be screened earlier.
If a woman walks in at the age of 30 and says that her mom was diagnosed with breast cancer at the age of 42, we recommend that she start screening 10 years earlier than her mother.
DNS: Are you still accepting participants for the three-year clinical trial on the effectiveness of ABUS?
Dr. Spear: Absolutely, we accept them every day. We’re hoping that the research will create the evidence needed to enforce more legislation and more insurance coverage for women who need ABUS.
When patients come in to have an ABUS, they receive a handout about the trials to study the efficacy of this particular tool, and told that they may be contacted. Interested women should call in to find out if they’re a candidate for this study.
Being an advocate for your own health is important and I encourage women to talk to their doctors, or to contact NorthShore (which includes Evanston Hospital, Skokie Hospital, Glenbrook Hospital and Highland Park Hospital). This test is not for everyone and it’s not to replace standard mammography, because a standard mammogram does show us the various characteristics of early breast cancer that cannot be seen in any other modality.
For more information visit: NorthShore Radiology Breast Imaging.
Christine Durkin, senior mammography technician at NorthShore University HealthSystem, uses the Automated Whole Breast Ultrasound on a patient; photos courtesy of NorthShore University HealthSystem
Dr. Georgia Giakoumis Spear