Mammography often cannot detect tumors in dense breast tissue
Mammography is used to identify malignant tumors in the woman's breast. In the past, however, it had been shown that the meaningfulness of the images is at least limited if the breast tissue of the women is very dense. Breast density is particularly high in young women. The density only decreases with age. In the USA, therefore, further procedures are to be used if women so wish. In Germany, such a procedure is not part of the health insurance screening program.
In Germany alone, around 60,000 women develop breast cancer every year. Around 17,000 patients die of cancer each year. "From the age of 50, the risk of developing breast cancer increases," reports the German Cancer Aid. If a gynecologist detects abnormalities during a so-called tactile examination, mammography usually follows. The X-ray examination should identify the cancer as early as possible, even in regular preventive examinations, in order to increase the chances of recovery for the patients. While the diagnostic accuracy is very high in older women, the procedure reaches its limits in younger women.
The reason for this is the density of the breast tissue, because then the X-ray image loses its significance. In the course of this, a debate has flared up in the USA as to whether women should be informed about their breast density by the doctor after a mammogram. Some US states are campaigning for additional information so that further examinations such as the ultrasound procedure can be carried out if necessary. In the meantime, some states, such as Texas, Connecticut, Virginia and currently New York, have introduced extended diagnostics and information.
High breast density increases the risk of breast cancer The reason: According to some studies, women who have high breast density, i.e. less fat tissue, but more glandular and connective tissue, have an increased risk of breast cancer. On the other hand, breast cancer cannot be clearly identified in the picture due to the nature of the breast and can therefore be easily overlooked. This is also confirmed by the “Mamazone” initiative (women and research against breast cancer) in Augsburg. According to the association, “the screening program is rather blind in around 30 percent of women”. About the proportion women have a high breast density. “Small limescale deposits can be found in mammography, which may represent a precursor to cancer. However, if the breast density is high, the chest X-ray is less successful in discovering tumor tissue ”.
As a rule, the density of the breast decreases with age. Most women have a rather mixed breast tissue. According to the American Radiology College, about ten percent of women have an almost complete adipose tissue. Radiologists report that another ten percent of women in the United States have “extremely dense tissue”.
Numerous cancer tumors not recognized by mammography In the past, many cancer patients were outraged by the fact that the doctor did not tell them that with high breast density, cancer tumors tend to remain hidden and therefore the diagnosis of mammography is incorrectly based on an unremarkable finding. But what should happen if the breast density is increased and screening is not sufficient? Can further examinations such as ultrasound provide better results?
The American Cancer Society is not uncritical about the call for an ultrasound examination. These are “not standardized and in some cases trigger false alarms”, as Otis Brawley reports. The result: unnecessary biopsies may actually be performed afterwards. Therefore, "we are moving in a gray area," said the expert. Anyway, the results are often wrong.
Experts call for additional ultrasound examination with high breast density Prof. Dr. Ingrid Schreer, from the breast center of the University Medical Center Schleswig-Holstein, explained that the overall situation in Germany was unsatisfactory. Every woman has the right to receive information about a higher breast density. The examining doctor should then recommend a supplementary ultrasound examination and scanning. However, advanced diagnostic procedures are currently not subject to quality assurance. Those affected often do not know how experienced and specialized the doctor is. "It would be much better to offer women with high tissue density supplementary sonography as part of the German mammography screening," the specialist told Die Welt. According to Schreer, this procedure is rejected by the Mammography Screening cooperation group in Germany.
"In the ultrasound examination, the sound waves from tumor tissue can be reflected differently than healthy tissue," warns "Mamazone". However, as with mammography, ultrasound diagnostics cannot make a “clear statement on the question of malignancy in numerous tumors”. This can only be proven by a biopsy. However, "shape, alignment, limitation and other parameters give first indications".
However, the screening program in Germany, which is initiated by the statutory health insurance funds and the medical associations, only suggests a free mammogram for cancer screening every two years to women between the ages of 50 and 60. The breast cancer self-help group "Mamazone" has been criticizing the mammography screening program for years. An additional ultrasound examination is "absolutely necessary so that women with high tissue density do not weigh themselves in false security". But the program rejects additional information about breast density. It is feared that women will be more unsettled than by learning useful details.
Study on improved diagnostics with high tissue density The US expert Karla Kerlikowske from the University of California has been dealing with the context between breast density and breast cancer for years. The globally recognized researcher is currently undertaking a larger study on this topic with a scientific team. The research is intended to determine which diagnostic methods are best for women with a high tissue density in order to detect tumors in good time. "In a year or two, we could make sensible recommendations," the scientist hopes.
The doctor has good news for women with high breast density. The tumors may be discovered later, apparently they are "less aggressive or difficult to treat than with soft tissue". This was the result of a study recently published in the journal "the National Cancer Institute" in which the expert was involved. (sb)
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