Make breast density reporting mandatory: RANZCR

Patients should be educated on their individual breast density following a mammogram in a bid to improve cancer detection rates.
 
That is according to an updated position statement from the Royal Australian and New Zealand College of Radiologists (RANZCR).
 
‘Whilst a future risk-based model for breast cancer screening is being developed, RANZCR recommends mandating the reporting of breast density in both screening and diagnostic settings in Australia and New Zealand,’ it said.
 
The plea comes after recent research found extreme mammographic breast density is associated with a 1.2–4 times higher risk of breast cancer.
 
According to BreastScreen Australia, more than half of all women under the age of 50 have dense breasts, as do about 40% of women in their 50s, often making cancer detection more difficult.
 
Despite this, only those living in South Australia and Western Australia are notified when a BreastScreen mammogram shows marked increased breast density.
 
Nationally, BreastScreen Australia says more research is needed before any new reporting models are established, saying current limitations in measuring density could produce inaccurate information.
 
‘This may create undue anxiety about risk and women may worry that their mammogram has missed a breast cancer,’ it said.
 
‘Conversely, women with fatty tissues and low breast density may have a false sense of security.’
 
However, Dr Katrina Tiller, Chair of RACGP Specific Interests Breast Medicine and a GP at the Sydney Breast Clinic, said women should have access to their personalised information.
 
‘Reporting breast density as the standard of care would allow practitioners and their patients to make more fully informed decisions about their health,’ she told newsGP.  
 
‘Breast density is a risk factor along with being female, getting older, drinking alcohol, having a family history of breast and/or ovarian cancer, and so on.
 
‘The skill of the GP, the breast physician, breast surgeon, and geneticist is conveying the whole picture to the person and discussing what options are available and the person being comfortable with their decisions regarding their health.’
 
In Australia, 1.8 million people aged 50–74 participate in a BreastScreen Australia screening each year, around half of the eligible population.
 
In many states, those wanting an assessment of their breast density currently need to ask their doctor for a referral for a mammogram at a diagnostic imaging service.
 
But Dr Tiller said the more knowledge patients and their doctors have, the better.
 
‘Knowing breast density, along with other breast cancer risk factors, allows discussion with a person about best imaging techniques to use for that particular person,’ she said.
 
‘People should not be “screened” for breast cancer when they have a symptom, they need diagnostic imaging, this is not a 2D mammogram.
 
‘People may not be aware of other modalities of imaging additional to 2D mammography that are available if they’re in a higher risk group, including 3D mammography, contrast enhanced mammography, ultrasound, and MRI.’
 
The RANZCR said the European Society of Breast Imaging had ‘aspirational’ guidelines, which call for women aged 50–70 with extreme breast density to undergo a breast MRI every 2–4 years, in addition to a mammogram.
 
‘Economic, human resources and accessibility may make adopting these recommendations difficult at this time,’ it said.
 
‘However, RANZCR will be working towards a model of this gold standard with governments and regulatory agencies.
 
‘RANZCR supports discussion and collaboration between a patient and their healthcare team to encourage shared decision making.’
 
Breast cancer is currently the most diagnosed cancer among women in Australia with more than 20,000 people diagnosed each year.
 
Over the past decade, breast cancer diagnosis has increased by 21%, and one in seven women will be diagnosed in their lifetime.
 
With these statistics in mind, Dr Tiller said moving forward, breast cancer education for the population and for practitioners is key.
 
‘Women don’t like mammograms, they tolerate them, so they may avoid them or use less validated tools,’ she said.
 
‘Sometimes messages get lost, and people think they can’t get breast cancer outside these active recruitment ages, or that all imaging is the same.
 
‘Discussing breast density is part of discussing breast cancer risk … it is some of the information needed to be gathered to assess risk comprehensively.’
 
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