Breast Density - Why It Matters, and Why the FDA's Ruling Comes Up Short

Last week, the FDA updated its rules about mammography and breast density. It is now required that women be notified of their dense breasts, and suggests "additional screening" if indicated. 

OK, well, it's a step in the right direction. I had dense breasts. So dense, in fact, that the 3.6 cm tumor growing there was missed year after year on mammogram. Unfortunately, those mammograms were dictated as Birads-2: "benign". They commented on density, yes - but the leap from 'you have dense breasts' to 'density hides cancer on mammogram' never happened in my mind. (Pictured above: my very dense left breast, with no evidence of cancer in 2020, that in fact, had a big lobular cancer.) 

So in 2020, when I felt a lump in my left breast, even though it felt weird and wrong, I LET IT GO. I did NOT SEEK CARE FOR A BREAST LUMP - please re-read that several times. I'm a physician. I knew it didn't feel right. But - "I had a normal mammogram 5 months ago, so this CAN'T be cancer" was my thought. 

How stupid I feel in retrospect. How angry I am that I waited another six f*ing months before getting that thing checked out. That thing that was very much a cancer, a big one, sitting there invisibly on my mammogram. I let the false reassurance of that mammogram delay my diagnosis. I knew my breasts were dense. I know now that that having dense breasts

a) increases the risk of developing breast cancer (independent of family history, lifestyle, BMI, genetics)

b) decreases the sensitivity of mammogram 

So the new FDA rules requiring notification of density and suggesting additional imaging for women with dense breasts are great. But there is zero mandate that anyone actually pay for that additional screening - so it's all fine and good to suggest maybe you need an ultrasound or an MRI, but those are expensive and require either good insurance, or mandates for coverage. Most women in the US have neither. You will need to advocate for yourself, especially if you are young and "without risk factors", to get additional screening. But please do it if you have any concerns, and dense breasts. Do not be falsely reassured as I was by "normal" mammograms. They weren't normal, they were hard to interpret due to the density. Density plus the sinister pattern of lobular carcinoma were a deadly combo that fell through every possible hole in the Swiss cheese of cancer screening. I did everything I was supposed to do, and my tumor was already stage 2 by the time it was diagnosed. 

Re-read your last mammogram report, and find out if you have dense breasts. If you do, get additional testing for absolutely any concerns or changes.
It might save your life.