The FDA’s new mammogram guidelines are changing what patients need to know
Women who get their regular mammograms can get new information about their breast density results.
A ruling from the Food and Drug Administration requiring mammogram devices to inform patients about breast density — a measure of a woman’s breast tissue — took effect Tuesday.
It’s a good first step for patients to understand their breast cancer risk and if they need further screening, health experts say, since mammograms are difficult to detect in dense breasts. . The national requirement also helps to standardize mammogram reports across the country, removing many different tasks from each state.
But experts also say it doesn’t go far enough because it doesn’t guarantee that insurance companies will cover additional ultrasound or MRI tests for women with dense breasts, even if health care providers they encourage it.
Without insurance coverage, patients may delay further testing needed to detect – or prevent – breast cancer. And in a type of cancer where early detection is key to survival, health experts say this delay can make a big difference in treatment, costs, quality of life and even survival.
What is breast height?
Breast thickness measures the amount of fat tissue compared to other tissue that makes up muscle and milk tissue, called fibroglandular tissue.
Women with dense breasts have more fibroglandular tissue while women without dense breasts have more fat. Half of women have dense or very dense breasts, according to Memorial Sloan Kettering Cancer Center.
Patients cannot tell their breast thickness by the size or shape of their breasts, said Dr. Carolyn Malone, a radiologist at Hackensack Medical Center in New Jersey. Breast thickness does not change with diet, exercise or other lifestyle changes.
“We all know that women have different breast sizes – this is the same principle,” he said. “Breast density is who you are.”
However, breasts can lose their firmness as a woman ages, usually during menopause.
Do thick breasts increase the risk of cancer?
Women with dense breasts are more likely to develop breast cancer, according to the Centers for Disease Control and Prevention.
Types of cancer in fibroglandular cells – not fat cells, said Dr. Anita Mehta, assistant professor of radiology at the GW Cancer Center. Women with dense breasts may be more likely to develop breast cancer because cancer is more likely to develop in a breast that has more fibroglandular tissue.
Mammograms, a type of X-ray, have great difficulty detecting cancer in dense breasts.
On a mammogram, fat cells appear black on the image, while fibroglandular cells appear white. Cancer also appears white on X-ray, so it can be difficult to detect cancer if it is surrounded by many fibroglandular cells, several experts said.
Teri Thomas, CEO of Volpara Health, a software company that helps families understand cancer risk and early detection, said: “It’s like looking for snow in a snowfield. “Cancer is very easy to hide in dense breasts.”
After a mammogram, health care providers may recommend women with dense breasts get a breast ultrasound or magnetic resonance imaging (MRI), which is more sensitive for detecting breast cancer. And it’s not recommended for routine screening, because they’re expensive and more likely to show suspicious areas that could be misdiagnosed as breast cancer.
What to expect from your next mammogram
Women will not see any changes on their regular mammograms. The new FDA rule will be reflected in their results.
In addition to finding out whether or not cancer has been diagnosed, women will be able to see a general assessment of their breast size ranging from “fairly fat breasts” to “very thick breasts.”
There will also be an overview explaining how dense tissue makes it harder to find breast cancer on a mammogram and raises the risk of developing cancer, encouraging patients to talk to their healthcare provider. health related to breast cancer.
Before the FDA’s decision, 39 states and Washington DC had federal mandates that required mammogram facilities to inform patients of their breast density or to inform them of breast density, generally. , said Mehta. Now, the news will be the same across the country.
However, insurance coverage for the recommended additional testing will not be available.
Does insurance cover breast ultrasounds, MRIs?
Routine and recommended mammograms have been covered by private insurance since the 2010 passage of the Affordable Care Act, also known as Obamacare. But coverage for additional screening for breast cancer and other risk factors varies by state and insurance.
Some insurances require prior approval from health care providers, Thomas said, while others may require a patient to pay their own fees before undergoing tests.
The lack of universal coverage for breast ultrasounds and MRIs is forcing many patients with dense breasts to delay recommended screening while they learn how to get it, health experts say. beauty they say. The cost of an ultrasound can be a few hundred dollars while the bill for an MRI can easily reach $1,000.
Political situation:Patients hate American health care. But the presidential candidates are not talking about it.
When patients delay screening, Thomas said, cancers that go undetected on mammograms can spread, increasing the need for more aggressive treatment and worsening their chances of survival.
Early breast cancer has a 99% 5-year survival rate, according to the National Breast Cancer Foundation. That drops to 86% with stage 3, which is considered advanced stage cancer.
Policymakers are committed to addressing unforeseen issues. A bill introduced in Congress in May 2023, called the Find It Early Act, would ensure full insurance coverage for women with dense breasts to receive additional screening.
The bill has been endorsed by medical organizations such as the American Cancer Society and the American College of Surgeons. Thomas, whose company Volpara Health also supported the bill, said more screening for women with dense breasts is medically necessary and the US needs to catch up with other countries that have the money. there are many that cover it.
“As a nation, we can do a lot better,” he said. “It hurts me as an American that we have such a short-sighted view of these issues.”
Adrianna Rodriguez can be reached at adrodriguez@usatoday.com
#FDAs #mammogram #guidelines #changing #patients