New GP guidance for women with high breast density

New guidance aimed at GPs managing and advising women with high breast density has been published this week by the Australian Government.
 
The Breast Density GP Guidance is designed to help bring national consistency to advice about the risks for women identified with dense breasts following mammogram screening.  
 
Associate Professor Magdalena Simonis is a Melbourne GP with a special interest in women’s health who sits on the BreastScreen Australia Clinical Advisory Group that endorsed the guidance this month.
 
‘What we have found is that it is not as easy to differentiate very early cancers, or some types of cancer, from the tissue when there’s a lot of fibroglandular tissue,’ she told newsGP.
 
‘The two-dimensional mammogram is not as efficient at differentiating fibroglandular tissue and very early cancer in some breasts.’
 
She said density can change over time and has nothing to do with the way breasts look.
 
There are four density categories under the Breast Imaging Reporting and Data System (BI-RADS), with BI-RADS category A denoting entirely fatty breasts, moving through to BI-RADS category D which signifies extremely dense breasts.
 
As well as reducing the visibility of cancer on mammograms, dense breasts are associated with a slightly higher risk of breast cancer.
 
Women identified as BI-RADS Category C and D, around 40% and 10% of the total respectively, are advised to consult their GP further under the guidance.
 
‘What we’re suggesting is that the woman goes and has a conversation with her GP upon receiving a result of categories C or D to discuss further investigations that may or may not be necessary,’ Associate Professor Simonis said.
 
‘The most important thing is that women, when they get their mammogram result from breast screening, understand what their category is – whether it’s A, B, C or D – and that helps them decide what to do beyond that.’
 
She says a nuanced conversation is required in subsequent discussions, covering other risk factors such as smoking, family history, any previous record of cancer and lymphoma, genetic profile and lifestyle, as well as breastfeeding history.
 
‘This is going to be a real partnership between the doctor and the woman to help her understand that the risk is an estimate, and that it can also change with time,’ she said.
 
‘Breast density is not the most significant factor that impacts breast cancer risk.
 
‘It does pose an increased risk factor, but it is not the strongest risk factor, so we need to be mindful of that.’
 
Professor Jon Emery from the University of Melbourne’s Department of General Practice and Primary Care, said the guidance will help address a gap in many women’s understanding.
 
‘Women with dense breasts may benefit from a discussion with their GP about their breast cancer risk management, including additional imaging tests,’ he said.
 
‘The guidance has been created with input from breast specialists, radiologists, GPs, policymakers, researchers, and consumers, in consultation with RACGP, and aims to fill a critical gap in patient care.
 
‘It addresses a significant knowledge gap among women, with many unaware of breast density’s impact on cancer detection and risk.’
 
There were around 1.95 million participants aged 50–74 screened through BreastScreen Australia in 2023–2024, around 52% of the eligible population.
 
In recent years, there has been increased discussion about the importance of reporting breast density following mammograms.
 
BreastScreen Australia programs already report breast density in some states, including South Australia, Victoria, Western Australia and New South Wales, with other jurisdictions now set to follow.
 
Associate Professor Simonis stressed the impact of the national screening program so far.
 
‘What’s really important to emphasise here is the current BreastScreen program that has been instituted since 1991 has been a very successful program that has reduced the overall mortality from breast cancer by 50%,’ she said.
 
‘In a country where we have one of the highest rates of breast cancer globally, that’s a really significant success story.’
 
The new breast density guidance for GPs is available on the Department of Health, Disability and Ageing website.
 
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