Options for screening Dense Breasts

Henda's Law Early in 2011 the Texas Legislature passed a law, House Bill 2102, which went into effect September 1, 2011. The law is known as Henda’s Law. It is named after Henda Salmeron, a Dallas realtor and breast cancer survivor who was instrumental in organizing the effort to draft and pass the legislation in Texas. The law requires mammography providers to notify their patients with dense breast tissue that their mammogram may be less accurate than that of women with lower breast density. The law’s intent is to make women with dense breast tissue aware that, in addition to their annual mammogram, they may benefit from “supplemental screening” such as breast ultrasound or MRI, especially if the woman has additional risk factors for breast cancer.




Getting smart about being dense can help in early cancer detection.  Mammograms are one of the most effective tools in detecting breast cancer. In women with dense or nonfatty tissue, however, detection can be difficult and additional screening may be needed.

One Dallas woman’s personal battle with breast cancer was the inspiration for Henda’s Law – a state law signed into effect June 17 that requires women to be informed about their breast tissue’s density and the limitations of mammography in certain cases. Dr. Roshni Rao, assistant professor of surgery at UT Southwestern Medical Center, was Henda Salmeron’s breast surgeon whose work helped drive passage of the law.

“Breast tissue that has minimal or no fat may appear white, or dense, on a mammogram. This sometimes makes it difficult to identify cancers, which also typically appear as small white spots,” says Dr. Rao.

Radiologists use a grading system to describe the density of breast tissue based on the amount of fat (nondense) and connective (dense) tissue. Research is ongoing as to why some women have denser breast tissue but generally, as women age, their breast tissue becomes more fatty.

“Many factors contribute to a woman’s risk of breast cancer. Having dense breast tissue may be one of them, but your doctor considers other factors when evaluating your risk and tailoring your screening program,” Dr. Rao says.

Those factors may include the age at which you had your first child, family history of cancer or your age at the onset of menstruation, among others.

 Starting at age 20, a yearly breast exam by a doctor is recommended. Every woman older than 40 should get screened annually. For women with dense breast tissue, digital mammograms may be better at finding cancer. Other tests – breast magnetic resonance imaging, ultrasound and breast thermography – also may be helpful, but only when added to mammogram results.

 Additional screening tools include:
 • Magnetic Resonance Imaging involves the use of magnets and computers to create three-dimensional images of the breasts. The scan can reveal masses and is sensitive enough to detect increased vascularization (blood vessel formation) that feeds tumors. This test can also detect tumors in dense breast tissue. They are not a first-line method of screening due to their cost.
• The HALO Breast Pap is a noninvasive, five-minute test that analyzes breast fluid for abnormal or precancerous cells. The HALO test may be able to help determine breast cancer risks up to seven years before traditional exams would detect a lump. The HALO is recommended for both young and middle aged women (25-60). A new technology not yet well known, the HALO test is FDA approved and not covered by the majority of insurance companies, but may be reimbursed or covered by flexible spending or Health Savings accounts. Call 832-237-4200 to schedule
 • Breast Ultrasound is a noninvasive and painless procedure that uses sound waves to make a picture of the tissues inside the breast. Ultrasound is excellent at detecting and discriminating between tumors and benign cysts (fluid pockets). This method is also able to scan the whole breast instead of imaging the breast in sections. Ultrasound is particularly helpful for women who have dense breast tissue. This is because dense tissue and cancer both tend to show up as the same color on a mammogram, but are easily discernable in an ultrasound (cancer is dark and dense tissue white).

• Thermal Imaging examines changes in the temperature and blood vessels of the breasts which show signs of possible cancer or pre-cancerous cell growth. Thermal Imaging can screen for cancer and notice physiological changes years before most other screening methods. This technology is painless and includes no bodily contact. In contrast to all the other tests, thermographic studies look at the function of the body, not its structure and therefore take an entirely different approach to detection of abnormalities. Breast Thermography is FDA approved and not covered by the majority of insurance companies, but may be reimbursed or covered by flexible spending or Health Savings accounts. Every type of breast tissue can be imaged – dense, fibrous, implants young or pre/post menopausal- with this non-invasive, painless radiation-free medical device.Call 832-237-4200 to schedule

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Breast Self Exam is an exam that women perform themselves. First a physician will teach how to perform the exam and what specifically to look for. The breast self-exam includes looking at and feeling one’s breasts to detect any changes or lumps.



 BREAST DENSITY FACTS
• 2/3 of pre-menopausal and ¼ of post menopausal women have dense breast tissue
• Cancer is 5 times more likely in women with extremely dense breasts
• A mammogram will find only 48% of tumors in women with the densest breasts (and therefore elude early detection)
• Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer
• Cancer recurrence is four times more likely in women with dense breasts If a mammogram is supplemented with an ultrasound or MRI, tumor detection rate increases at least 30%


 Test yourself for Familial or Sporadic Breast Cancers

Most cases of breast and ovarian cancer happen by chance and are not caused by an inherited mutated gene. For assessing the risk of sporadic (non-familial) breast cancer, there is the BREVAGen test. By combining both clinical risk factors with an individual’s genetic markers, BREVAGen provides a 5 year and lifetime percentage risk of developing breast cancer. BREVAGen™ is a first-in-class predictive risk test for sporadic breast cancer.
As a noninvasive oral swab test, BREVAGen is very easy to use in the clinic setting. The BREVAGen™ test provides information about breast cancer risk; it does not diagnose breast cancer

• BREVAGen is currently validated in Caucasian women of European descent 35 years of age or older • The risk estimate used in this test does not take into account several other breast cancer risk factors, such as an extensive family history of breast and ovarian cancer 

• This test is used for clinical purposes http://brevagen.com/home 

However, when several members of a family have developed the same type of cancer, or when individuals develop cancer at an unusually young age (less than 50), it is natural to question whether an inherited factor is involved. Having a mutation of the BRCA1 or BRCA2 gene increases the risk of breast cancer far more than does any other known risk factor for this disease.
BRCA genetic mutation
• Causes about 10% of breast and ovarian cancer
• Substantially increases your risk for developing breast and ovarian cancer, often before the age of 50
 • Is most often due to a mutation, or alteration, in either of 2 genes: BRCA1 and BRCA2
• Can be inherited from either your father or your mother
• Can be passed on to your children if you have it





If you have painful tender breasts, try an herbal supplement to reduce symptoms before your appointment for breast imaging studies.

An aromatase inhibitor/estrogen blocker formula may decrease the estrogen stimulation of breasts and make imaging the breast easier if breast stimulation and inflammation is the issue . This formula contains many aromatase inhibiting compounds, including green tea, pomegranate, resveratrol, turmeric, and astralagus.


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