Did You Receive a 'Dense Breast' Letter? Don't Panic

By James Crawford, MD, Breast Surgeon—Virtua Breast Care

Several years ago, New Jersey enacted a law that requires all women who get mammograms to receive a follow-up letter noting if they have dense breasts.

The lawmakers clearly had good intentions—dense breast tissue makes it harder to detect tumors via mammogram. But, this letter can strike a bit of fear in women because, as it stands, it doesn't provide particularly helpful or specific information about your breasts—it just says if you have dense breasts and need further testing.

Breast imaging centers are re-evaluating how they should notify patients who have dense breasts or extremely dense breasts versus those who have breasts with a few scattered areas of density. 

But, before you start to worry, here’s the lowdown on the law, the letter, and what you need to know.

Got the letter? First things first—don’t panic

Every woman is getting this letter, and it says you do or don't have dense breasts. If you’ve had a mammogram recently, you will get the letter.

The two brave women behind the New Jersey legislature both were diagnosed with breast cancer shortly after being given the all-clear via mammograms. In both cases, having dense breasts made it harder for radiologists to see suspicious or cancerous spots on their mammograms. Hoping to ensure that this never happened to another woman, they sought to enact legislation that would make all women aware of this troubling possibility.

And, in fact, a lot of women do have dense breasts. Breasts are made up of connective tissue and fat. The ratio has a lot to do with age. If you’re 40, you’re likely to have more connective tissue and less fat—these are denser breasts. Once you’re, say, 65, you’ll have much more fat and much less connective tissue.

Why does density matter?

This ratio of connective tissue to fat has serious implications for mammography. On a mammogram, fat is gray, and connective tissue is white. Tumors are also white. It's possible for a tumor to “hide” in a dense cluster of connective tissue.

There are also variations in density that make this more or less likely. With digital mammograms, you can manipulate the image to look more closely at the breast tissue in women with dense breasts. If your breasts are extremely dense, however, and there’s cause for concern upon examination, you should be referred for additional screening.

Other breast cancer screening methods

If there’s one takeaway, it’s that mammography is only one tool in the breast cancer detection toolbox. Doctors, and women, have many other methods at hand— literally starting with our hands.

Self-breast exams at home, and manual breast exams by your doctor at your annual gynecological visit, are the first line of defense. While most breast cancers are too small to feel, sometimes your doctor will feel something unusual. There’s a lumpy spot, a texture change, or something that's off or different. 

The patient history also plays a big part. Your doctor can compare this year’s mammogram to last year’s to get a better sense if anything’s changed.

If something doesn’t feel right during an exam, and the mammogram doesn’t turn up anything, there are other screening methods to try. Breast ultrasound, breast MRI, and breast tomosynthesis (also known as 3D mammography) are all viable options. Each test has its strengths and weaknesses. 

Technology hasn’t arrived at the perfect breast cancer detection method yet, but your doctor will be able to walk you through the screening scenario that makes sense for your particular situation. 

Schedule a mammogram online today or request an appointment. 

Updated March 27, 2023