Nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them. While many women already know this information about their bodies, starting next year, a new FDA rule will require that clinicians notify all women if their mammogram shows that they have dense breasts. The challenge is ensuring our patients understand what to do about it.
When my colleagues and I at the U.S. Preventive Services Task Force reviewed all of the latest scientific evidence around breast cancer screening for our new draft recommendation, it became clear that there is not enough research available to tell us whether and how women with dense breasts should get additional testing. The research doesn’t show whether the right answer is an ultrasound, an MRI, or something else entirely. And it doesn’t tell us how often these additional screenings should happen.
There’s no question that there is a problem here. Women deserve to have high-quality science available to guide their decisions on whether, when, and how to get screened — especially those women who we know are more likely to get breast cancer. Yet, this information is woefully absent from the scientific literature. No matter how much we may want to, the Task Force can’t make a recommendation on any additional tests for women with dense breasts without that evidence. We simply can’t be confident that what we’re recommending will help women get and stay healthy.
All our recommendations are focused solely on what high-quality science shows, not on what we all wish we knew. Because science on additional screening is lacking here, we are issuing an urgent call for more research. All health researchers and research funders should consider this a top priority. They must work as quickly as possible to complete the appropriate studies and allow us to come to a strong recommendation that can help women with dense breasts and their clinicians know the best screening approach.
In the meantime, the most important thing we must make sure our patients know is that starting to get screened for breast cancer every other year when they turn 40 just might save their life. Mammograms are an imperfect yet critical tool in helping find and treat cancers early. Getting timely mammograms is vital for women with dense breasts, who should then talk with their clinician about which — if any — of the additional screening approaches are right for them. These decisions should be made between patients and clinicians with as few barriers to care as possible.
Women have long been underrepresented in the scientific literature. As half of the population, we are equally worthy of scientific answers to the most challenging questions about our bodies. We should all be getting screened for breast cancer every 2 years starting at age 40, but we should also all raise our voices to demand that researchers work as quickly as possible to find out whether there is anything else that women with dense breasts should do to protect their health. We deserve nothing less.
Carol M. Mangione, MD, is immediate past chair of the U.S. Preventive Services Task Force.