Knowing Your Breast Density Can Save Your Life

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“Mammogram” and “survivor” are now popular vocabulary, but there’s a less familiar term that directly connects to both: breast density.

Breast density is an unpopular subject among women, but only because they typically don’t know it even exists. Specifically, it is a higher proportion of connective tissue versus fatty tissue that categorizes in four ways:

A. Almost Entirely Fatty

B. Scattered Fibroglandular Density

C. Heterogeneously Dense

D. Extremely Dense

dense breasts graphic

(c) 2015-2016 DenseBreast-info, Inc.

 Only about 10% of women have breast tissue that fall under A, and another 10% that fall under D. Why does it matter how dense your breasts are? A high proportion of connective tissue can compromise a mammogram’s accuracy since it’s nearly identical to cancer cells. It could throw off your results, meaning someone’s breast cancer could go completely undetected.

The earlier a diagnosis, the higher the chances of a recovery. Without knowing your breast density, you could be developing breast cancer unknowingly for years. In fact, you could be like JoAnn Pushkin, who only learned about breast density the day she was diagnosed with Stage II breast cancer.

Pushkin is a breast cancer survivor, author, speaker, and advocate. She co-founded the Dense Education National Survivors’ Effort, or DENSE, and is the executive director of DenseBreast-info, Inc., an information resource that provides much-needed breast density information for health care professionals and patients.


“I mentor women in their own states who are advocating for breast density inform laws where they live.” – JoAnn Pushkin

Along with Pushkin, DENSE was created in 2010 by six women fighting for state density inform laws.

“My own tragedy of a later-stage cancer missed by mammography was the inspiration for New York’s Breast Density Inform law, which went into effect in January 2013. After the law went into effect, I began to get calls from both women and their doctors confused as to what the new notification meant in terms of screening and risk.”

To address this educational need, Pushkin co-developed DenseBreast-info.org with breast imaging expert Dr. Wendie Berg, MD, PhD, and mammography technologist, Cindy Henke-Sarmento.

Pushkin received her regular mammograms on-time for years with no sign of anything that could be malignant, so her diagnosis came as a shock.

“Because my cancer was missed an estimated five years in a row hidden behind dense tissue, it was finally detected when large enough to be felt and no longer early stage. I’ve had eight surgeries, eight rounds of chemotherapy, 30 rounds of radiation, and a recurrence. I tell people I am what it is to live life as a time bomb.”

Her mammogram letters reported all was normal, but she scrutinizes it as a medical “lie by omission” by not knowing the effectiveness of the mammogram.


With this considered, why aren’t doctors informing patients about breast density? The short answer is they never had to under state laws, and some wish to keep it that way. Personal breast density information is available, but not typically given to patients. Women can always request to read their full mammography report, but they typically never do, especially after being given an “all clear” from their doctor. Even with it, there can be confusion about what breast density is.

“There is some resistance to density inform bills. Many doctors felt they didn’t want medical care legislated, others have workflow concerns, for example, ‘Are there enough technicians to do ultrasounds?’, while others have insurance coverage concerns. Generally, even if a state does not have an insurance law in effect, an ultrasound, or possibly other screening, will be covered if ordered by a health care provider.”

Thanks to the efforts of breast density advocates like Pushkin, now 27 states have mandatory breast density inform laws in effect. However, not informing patients of breast density isn’t necessarily a malicious endeavor. Some doctors, due to how common dense breast tissue is,  don’t want to cause their patients undue fear or paying for unnecessary screenings. Yet, precautionary screenings are usually a better option than untreated breast cancer, which is not a unique case for Pushkin.

“There were women in the same situation as me who had ‘normal’ mammograms and yet were diagnosed with later stage cancers. In women with extremely dense breasts, cancers are almost 18 times more likely to be found because they are large enough to feel soon after a ‘normal’ mammogram than women with fatty breasts. My situation was not unusual. I felt an obligation to prevent my tragedy from taking a seat at anyone else’s kitchen table; additional screening after mammography would have detected my cancer at an earlier stage.”

Mammograph of a Dense Breast

(c) 2015-2016 DenseBreast-info, Inc.

After Pushkin felt her own lump, her doctor recommended a diagnostic mammogram and then an Ultrasound. People also have the option to receive a Magnetic Resonance Imaging (MRI), which finds the most breast cancers of any imaging procedure currently in widespread use. Ultimately, risk and options should be discussed with your personal health care provider.

“I want readers to know their own risk factors – family history, their own history and if their mammogram indicates they have dense breasts. If you don’t live in a state with a breast density law requiring you receive the information, you should call the facility where you had your breast imaging done or referring health care provider to get the full report of your mammography examination. It should contain information about your breast density.”

To view an interactive map with the state laws, courtesy of DenseBreast-info, Inc., visit: http://densebreast-info.org/legislation.aspx


Destini "D.K." Billins is a graduate from the University of Georgia who describes herself as a transmedia professional and writer. She has a passion for all things involving media and social progress, but most importantly, she has a really cute Shih Tzu named Titan.

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