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Q&A with László Tabár: The Benefits of Mammography & Ultrasound for Women with Dense Breast Tissue

Dr. Tabar is Professor emeritus of Radiology, University of Uppsala School of Medicine, Sweden, former Medical Director of the Department of Mammography, Falun Central Hospital, Sweden, and Consultant Radiologist for numerous Comprehensive Breast Centers in the United States.

Dr. Tabar is Professor emeritus of Radiology, University of Uppsala School of Medicine, Sweden, former Medical Director of the Department of Mammography, Falun Central Hospital, Sweden, and Consultant Radiologist for numerous Comprehensive Breast Centers in the United States.

Dr. László Tabár* is a visionary physician, researcher, and educator who has contributed significantly in the worldwide fight against breast cancer. Here he gives his thoughts about the significance of mammographic breast density and the cancer risk associated with breast density.

Dr. Tabár is Professor emeritus of Radiology, University of Uppsala School of Medicine, Sweden, former Medical Director of the Department of Mammography, Falun Central Hospital, Sweden, and Consultant Radiologist for numerous Comprehensive Breast Centers in the United States.

1. What is the significance of mammographic breast density?

The imaging (mammographic) appearance of the normal female breast varies from woman to woman and also, it varies in the same woman from decade to decade. Also, both the benign and malignant breast diseases are very heterogeneous, therefore there is currently not a single imaging method that can image all the normal or abnormal breast lesions equally well. This complex problem can be overcome by using the “multimodality approach”, especially when the breast tissue is “dense”. Dense breast tissue means that a possible abnormality that is present cannot be visualized as well as in fatty replaced, adipose breasts.

2. How high is the cancer risk associated with breast density?

Approximately 40-50% of the asymptomatic women aged 40+ years old have “dense breast tissue”, but it would be a mistake and unrealistic to call all of them a “high risk” individual for developing breast cancer based on breast density alone. There are three different types of “dense breasts”: women with Type I mammographic parenchymal pattern have an “average risk” of developing breast cancer, while women with Type IV (12% of all women >40 yrs of age) and Type V mammographic parenchymal pattern (5-8% of women >40 yrs of age) have a two-fold increase of developing a breast cancer (relative risk 1.91, 95% confidence intervals 1.26-2.9). (Link to full study)       

Dense Breast 1   Dense Breast 2   Dense Breast 3   Dense Breast 4

“Dense” Type I breasts (normal risk).

 

High Risk IV 1   High Risk IV 2  High Risk IV 3   High Risk IV 4

High risk mammographic parenchymal pattern, Type IV.

 

High Risk V 1   High Risk V 2   High Risk V 3   High Risk V 4

High risk mammographic parenchymal pattern, Type V.

3. Should a woman with dense breasts still get a mammogram?

Yes, there is no reason to eliminate the mammogram from the diagnostic tools. One main reason is that the mammograms demonstrate microcalcifications exquisitely while the ultrasound can hardly detect them; on the other hand, a small breast cancer may be hidden in the dense portion of a “dense breast”, where the ultrasound examination is very efficient in finding non-calcified invasive breast cancers. Therefore, the two methods are complementary, instead of replacing each other.

4. What can impact the quality of breast care?

The quality of breast care can be determined by the proper use of the multimodality approach, which helps support equally high quality care to women irrespective of their mammographic parenchymal patterns.

A recent study commissioned by Working Mother Media which investigated the awareness of dense breast tissue in American women, revealed that public awareness of this was still low and that there are still many myths that need to be debunked, as this infographic shows.

* – Dr. Tabar is a paid consultant for GE Healthcare.

 

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