What Patients Can Expect: Future of Breast Cancer Screenings

Here are some numbers that relate to breast cancer detection and self care:

  • 40 – the age recommended for women to have annual mammograms.
  • 50 – the percentage of cancers in women with dense breast tissue that can be missed by standard mammograms.
  • 40 – the percentage of women who have dense breast tissue

What is dense breast tissue?

The Breast Imaging Reporting and Database Systems, (BI-RADS) which reports the findings of mammograms, also includes an assessment of breast density by four groups:

  • Mostly fatty: The breasts are made up of mostly fat and contain little fibrous and glandular tissue. This means the mammogram would likely show anything that was abnormal.
  • Scattered density: The breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue.
  • Consistent density: The breasts have many areas of fibrous and glandular tissue that are evenly distributed through the breasts. This can make it hard to see small masses in the breast.
  • Extremely dense: The breasts have a lot of fibrous and glandular tissue. This may make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue.

Breast density is not based on how your breasts feel during a self-exam or a doctor’s physical exam. However, breast density is determined through a mammogram.

Cancers appear as white objects in a breast x-ray. If a white object is shown on a white or dense background it’s much harder to see than if presented on a dark or background. Improved screenings can better detect those hard to see cancer spots.

Early Detection: Since 1990, the death rate from breast cancer has significantly declined. The reason? Early detection and more sophisticated breast screenings.

Following are some responses from Doctor Patterson about those advances:

When 3D mammography (digital breast tomosynthesis) was introduced it was called a revolutionary new screening and diagnostic breast-imaging tool with the ability to improve early detection of breast cancer. How does that work?

“Tomosynthesis is a new and improved mammogram and starting to replace the 2D mammogram. We know it’s better and can better detect cancer. Most IU Health centers have 3D mammograms. Up until two months ago, we gave women the option of 3D. There are a few women who we don’t do 3D because their breast are large enough that the 3D images are not as clear.  It is definitely appropriate for women to ask if they are a good candidate for 3D mammography.”

It’s been reported that the more dense the breast tissue, the greater the risk of masking cancer detection. Ultrasound, when combined with mammography, can increase the accuracy and detection of breast cancer in dense breasts by 35.7 percent. What else can be done to help patients know that they have received the best scan possible?  

“We are now being trained on Automated Breast Ultrasound Screening (ABUS). IU Health is the first provider in the state to use this technology. Our overall goal is personalizing what is best for our patients. Using ultrasounds for breast cancer screenings is not new, but the equipment is more sophisticated. What we know is breast ultra sound can detect more cancers. As the technology has improved with automated ultra sound, the images are so much better and we can decrease the false positive rate. Another advantage to this type of ultrasound is that handheld ultrasounds could take up to an hour to complete. Now the automated ultrasound can be done in about 12 minutes. We hope to begin scheduling patients by the end of the month. This will be for women who have a high risk of breast cancer.

How do health providers provide the best follow up screenings for patients?

“A lot of health facilities offer risk assessments. So if the patient for instance, has a family history and may be at a high risk, they may be recommended for additional imaging. Other patients with dense tissue may be recommended for the breast ultra sound. Our ultimate goal is do the screenings right there so they will know. We encourage patients to talk to their doctors about the best options.”

Additional resources about dense breast tissue:

  • http://densebreast-info.org
  • http://www.areyoudense.org

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
 T.J. Banes or on Twitter @tjbanes.