New FDA Ruling on Dense Breast Tissue: Doctor Explains How It Impacts Your Mammogram and Cancer Risk
Almost half of women over 40 have dense breasts, which raises the risk of breast cancer.
At your next routine mammogram, your report will include results on a new risk factor for breast cancer: dense breast tissue. New Food and Drug Administration (FDA) regulations now require mammogram facilities to notify patients if they have dense breast tissue—and understanding breast density is important for overall health. This big step aims to empower women with knowledge about their breast health and help them make informed decisions about their care.
To learn more about dense breast tissue, we spoke to Kiran Sheikh, MD, a breast imaging specialist and radiologist at Yale Cancer Center. She explains the new FDA ruling, why it matters and how you can stay proactive about your breast health.
Details on the new FDA ruling for mammograms
The new FDA ruling, finalized on September 10, 2024, requires “every mammogram…contain a breast density statement that informs the patient about their breast density,” explains Dr. Sheikh. “Although some states had previously required mammography facilities to notify patients of their breast density—such as Connecticut, FDA’s updated regulations now make it a national requirement.”
Every mammogram must clearly describe breast density as either “not dense” or “dense,” and an overall assessment of breast density must be communicated to healthcare providers without alteration. “The consistency in reporting promotes [a] better understanding for both patients and providers,” adds Dr. Sheikh.
With this new information, Dr. Sheikh emphasizes that patients can now take a more proactive role in their breast care, including “discussion and with their health care providers about their breast density, breast cancer risk and options for additional screening if needed.” However, the ruling does not guarantee insurance coverage for additional screenings, such as a breast ultrasound or MRI, which may be recommended for women with dense breasts.
What is dense breast tissue?
“Breast density refers to the amount of fatty, glandular and fibrous tissue in the breast,” explains Dr. Sheikh. Tissue can range on a spectrum from predominantly fatty to almost entirely dense.
“Dense breast tissue is where a higher proportion of the breast tissue contains fibrous and glandular—fibroglandular—tissue, which can increase your risk of breast cancer,” she says. “Fibroglandular tissue is more difficult to see through than fatty tissue on mammography, and small masses can be obscured by surrounding dense tissue.”
How common is it to have dense breast tissue? According to Dr. Sheikh, “Approximately 40 to 50 percent of women have dense breast tissue, and those women with ‘dense’ breast tissue have [a] 1.5 to 2 times increased risk of breast cancer compared to women with ‘not dense’ breast tissue.”
However, it’s important to note that having dense breasts does not mean you will get breast cancer. Most women with dense breasts will never develop breast cancer. Dr. Sheikh adds, “While dense breast tissue is a risk factor for breast cancer, it is just one of many factors, including genetics, age, lifestyle and hormone exposure.”
What causes dense breast tissue?
“Dense breast tissue is caused by many similar factors, mainly genetics, age and hormonal exposure,” says Dr. Sheikh. She adds that “younger women in their 20s and 30s tend to have denser breast tissue, which can become less dense after menopause due to hormonal changes.” She also cites women with hormonal exposure, including hormone replacement therapy (HRT) and pregnancy, and lower body fat percentage tend to have denser breasts.
What to do if you have dense breasts
If you have dense breast tissue, there are steps you can take moving forward. Most importantly, talk to your healthcare provider about the potential benefits of additional testing. “Since mammography may be less effective, additional supplemental screening methods—such as ultrasound or MRI—are recommended to help detect abnormalities in dense tissue,” adds Dr. Sheikh. If these aren’t covered by insurance, there are ways to save on them with grant programs, patient assistance programs and breast cancer organizations with low fees. You can learn more about the cost of additional screenings here.
How to lower your risk of breast cancer
According to the Centers for Disease Control and Prevention (CDC), all women are at risk for getting breast cancer. However, some factors can raise that risk before age 45. A recent study published in the Journal of Clinical Oncology found that Black women, for example, are more likely than white women to be diagnosed and die from all types of breast cancer.
Whether you have dense breast tissue or other risk factors, there are several steps you can take to lower your risk:
- Continue routine screenings: “The most important thing is to make sure you get regular screening mammograms and ultrasounds. Routine health checks are important, including annual breast exams by your gynecologist,” says Dr. Sheikh.
- Follow a healthy lifestyle: “Maintenance of a healthy weight, a healthy diet with limited processed food and red meat and routine exercise can all be beneficial in lowering your risk for cancer,” says Dr. Sheikh. Avoiding or limiting alcohol consumption may also help.
- Ask your doctor about hormone therapy: If you have a history of breast cancer or are at high risk, ask your doctor if it’s best to avoid hormone therapy, such as postmenopausal HRT.
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