Beyond Mammography (Podcast)

Breast density affects 50% of women and can significantly impact both cancer risk and early detection.

"If the amount of fibro glandular tissue exceeds the amount of fatty tissue in a breast, a woman is referred to as having dense breast tissue. Now, dense breast tissue appears white on a mammogram as does cancer. So dense breast tissue can obscure or hide breast cancer, which is why it is important that women are aware of their breast tissue density and why it's also one of the limitations we have with screening mammography"

In a recent episode of Cleveland Clinic's Cancer Advances podcast, breast radiologist Paulette Turk, MD, and Medical Breast Program Director Lakshmi Khatri, MD, discussed:

• Evolving national guidelines for breast cancer screening
• Higher risks associated with elevated breast density
• Supplementary screening such as digital breast tomosynthesis, whole breast ultrasound, breast MRI and molecular breast imaging
• Screening recommendations for those at higher risk due to gene mutations or chest radiation before the age of 30

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Cancer Advances episodes at clevelandclinic.org/podcasts/cancer-advances or wherever you get your podcasts.

Excerpt from the podcast:

Dale Shepard, MD, PhD: Can elaborate in terms of supplemental screening guidelines? What exactly are the triggers for who's high risk, who needs the supplemental screening, and then what kind of supplemental screening. What do the guidelines say?

Lakshmi Khatri, MD: So we can talk about high-risk women first because that's I think the easiest and that is one in which we do actually have guidelines. Those are women who have a calculated lifetime risk of 20% or greater, a residual lifetime risk for getting breast cancer. And that's based on statistical models that really rely heavily on family history, but do include density as well.

And women who carry a moderately or highly penetrant gene mutation that increases their lifetime risk as well for getting breast cancer. Or women who had radiation to their chest, so therapeutic radiation to their chest before the age of 30. And so those are the women who meet national criteria and guidelines for MRI surveillance and that is in high-risk women. And then when we're talking about women who are otherwise not high risk but have dense breast tissue, this is when the supplemental imaging comes in with, again, two modalities we have at the Cleveland Clinic, which include the whole breast automated ultrasound and an abbreviated version of that MRI.

And some institutions have other modalities. Other institutions do something like molecular breast imaging. The reason that it's so varied is because there are no guidelines. There are just recommendations. There is data out there that helps support the use of these modalities. And in 2022, actually in Ohio there was a bill passed requiring insurances to pay at least in part for supplemental imaging for women with dense breast tissue.