Breast cancer: Patients are told if they have dense breasts, but the conversation must continue

When women get screened for breast cancer, they are now getting more information than they did a few years ago.

Arif Kamal, MD, of the American Cancer Society, says the new FDA rule requiring mammogram results to include information on breast density is an important step. But doctors should reach out to patients to help make good choices about added screenings.

With a new Food and Drug Administration rule that took effect in September 2024, patients are now being told if they have dense breast tissue. Some states already had similar mandates, but the FDA rule requires information about dense breasts to be made available to patients nationwide.

Women with dense breasts have a higher risk of developing breast cancer, according to the American Cancer Society. Arif Kamal, MD, chief patient officer for the American Cancer Society, says the inclusion of information about breast density in mammograms is an important development that shouldn’t be underestimated.

“Without trying to be too hyperbolic, it might be the most common, impactful and under-recognized risk factor that exists in cancer right now,” Kamal tells Chief Healthcare Executive®.

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About half of all women have dense breasts, according to the Centers for Disease Control and Prevention. Breast density refers to the amount of fibrous or glandular tissue in the breast, compared to fat tissue. Importantly, density does not refer to the size or firmness of the breast.

Kamal likens higher breast density to driving on a road with heavy fog. Just as fog can obscure road hazards, higher breast density can make it more difficult to detect tumors. So patients with higher breast density may want to schedule more frequent screenings or other imaging tests to breast cancer, Kamal says. (See part of our conversation in this video. The story continues below.)

From Kamal’s perspective, not enough patients are having those conversations about the need for additional screenings.

“That, to me, is a bit of a red alert moment, because it's common,” Kamal says. “It's clearly associated with more cancer, and very few people are having something done about it.”

This is an area that doctors and health systems should be considering thoughtfully, Kamal says. It’s a breakthrough that women nationwide are now getting armed with more information that can help them prevent breast cancer. Kamal is grateful that the FDA has enacted the rule.

“It's pretty unusual for the federal government, for a healthcare issue, to standardize a process,” Kamal says.

On mammograms, women with higher breast density will see the following message: “Your breast tissue is dense. In some people with dense tissue, other imaging tests in addition to a mammogram may help find cancers. Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation."

While women are getting that notification, Kamal says healthcare providers should be encouraging more conversations with patients about the implications of having dense breasts and perhaps the need for additional screening.

“What I found that might be the most concerning is a bit of a presumption on the part of one party on the intentions of the other party,” Kamal says. "You actually have both parties presuming that the other party doesn't think it's a big deal, and so a conversation doesn't occur."

• Read more: How the American Cancer Society hopes to improve outcomes for Black women

For example, patients are now being told that they have dense breasts, but if they aren’t hearing from their physician or provider, they may not discuss additional screenings, because their clinician isn’t signaling that it’s important.

Conversely, doctors may simply assume that if patients were concerned and want additional screenings, the patients will schedule appointments.

“I think that part of the reason to bring visibility to this topic has to be to dispel this idea that just because you haven't heard anything, doesn't mean it's not important to have a conversation,” Kamal says.

“I think, if anything, we need to be talking to patients and saying, ‘Hey, this is kind of a big deal, and you wouldn't ignore anything else that doubled your risk of breast cancer,’” he adds.

Different patients have different levels of risk, and some patients may not need or want additional screenings. For a patient who is 75 and has dense breasts, the patient may simply choose to continue annual screenings, and Kamal says that may be a sound choice. But he says that the clinician should engage in a thoughtful discussion so the patient can make an informed decision.

However, a younger patient may choose to have more frequent screenings,

“That's why you need a tailored approach,” Kamal says. “But what we can't do is not have these conversations.”

• Read more: There have been big steps in the fight against breast cancer, and more are needed

Kamal recalls that years ago, clinicians had to be encouraged and trained to have conversations about the importance of getting mammograms. Now, he says, it’s time to talk to clinicians about having follow-up conversations about additional screenings for women with dense breasts, and perhaps getting more detailed information about family cancer history to better understand the patient’s baseline risk.

“I do think it's a combination of helping clinicians know what questions to ask, and making time and space to have that, but also, as a health system, figuring out if that's not the best approach, do you need a separate clinic or group that is following up on … those higher risk folks, to make sure that nothing falls between the cracks," Kamal says.