NEW ORLEANS, La. (WVUE) - While major strides have been made in fighting cancer, a federal agency wants to ensure that women have important information about a breast characteristic that could increase cancer risk.
"It absolutely saved my life. I do believe,” said Dianna Lauve.
For Lauve, an extra screening proved revelatory.
"I was diagnosed in August of 2017,” said Lauve.
She is a breast cancer survivor and credits a sensitive test with detecting the malignancy.
“Thanks to the MRI which because I had, had a mammogram, ultrasound just six months previous that didn't pick it up,” said Lauve, who is a radiation therapist who manages Radiation Oncology at Touro Infirmary in New Orleans.
Fortunately, she had been aware of her specific breast tissue for a while.
"Which after many years of getting annual ultrasounds and mammograms due to my dense breasts luckily the radiologist at our imaging center at Touro, Dr. Dan Rupley put me on a protocol of six-month interval MRIs, screening MRIs and it was the MRI that found the very small lump,” Lauve stated.
But many women are in the dark about the type of breast tissue they have and that concerns health professionals and for good reason.
According to the National Cancer Institute women with dense breasts have a higher risk of breast cancer than women with fatty breasts. And the agency says the risk goes up with increasing breast density.
"They have found in some studies that you are more likely to get breast cancer with dense breast and we're really unsure as to why,” said Dr. Elly Zakris, Director of Radiation Oncology at Touro, and a board member of Susan G. Komen New Orleans.
On mammograms, which are breast x-rays, dense tissue is cloaked.
Dr. Zakris explained why.
"Because when you look at a mammogram for you to see a cancer, the cancer shows up as being white spots and when you have dense breast tissue more of your breast looks white on a mammogram, so it's harder to find tumors in women with dense breasts but mammograms are still effective because they do show calcifications.
Still she said mammograms remain important for women with dense tissue.
"Sometimes cancers can be associated with calcifications which are little calcium deposits in the breast,” Zakris stated.
Breast tissue type cannot be determined by touch, only a mammogram can differentiate between dense and fatty tissue, according to the National Cancer Institute.
So, a proposed new rule by the Food and Drug Administration has grabbed headlines.
The FDA wants to amend the Mammography Quality Standards Act of 1992, and mandate that mammography facilities inform patients and their doctors in writing when dense breast tissue is detected, so discussions can be had about possible further screenings like ultrasounds and MRIs.
In announcing the proposed rule, the FDA wrote that it was, “...proposing specific language that would explain how breast density can influence the accuracy of mammography and would recommend patients with dense breasts talk to their health care provider about high breast density and how it relates to breast cancer risk and their individual situation.”
Dr. Zakris applauds the move.
"It's about time and so anything that improves early detection is really going to help cure more women with breast cancer,” she said.
The FDA says the change would also enhance its enforcement of mammography centers’ compliance with safety and quality standards.
"For the first time in 20 years the FDA has proposed new guidelines that women who do have dense breasts will be notified that they do have dense breasts which will place them at a higher risk of getting breast cancer. And the purpose of letting women know is so they can speak with their doctor to see if they do need other imaging tests performed,” Zakris said.
Dense breasts have higher amounts of glandular and fibrous connective tissue and it could be a function of a woman’s DNA.
“It kind of is, over half of women in our country over 40 have dense breast tissue, but yes it is partly genetic. Women who are thinner have a higher chance of having dense breast tissue,” added Dr. Zakris.
Current federal law requires mammogram providers to send written results of the x-rays to clients.
And according to DenseBreast-Info.org, Louisiana is among three dozen states with laws pertaining to women being notified of dense breast tissue. But state laws have varying language and may not always be enforced.
Lauve strongly supports the FDA’s efforts to have a minimum federal standard for notifying women.
"Because look at me for instance. If my radiologist would not have put me on the path of getting the MRI due to my dense breasts which he did let me know about from years past, I may have been discovered at a different stage,” she said.
Dr. Zakris was asked if all women with dense breasts should have regular ultrasounds and MRIs.
"Well, that’s a complicated question, of course, I support the additional imaging studies, but not everyone with dense breasts needs a breast ultrasound, or a breast MRI every year, so it depends on what other risk factors that you have for developing cancer,” responded Zakris.
Risk factors go beyond family history.
"Having early periods, late menopause, not having children are all small risk factors,” Zakris stated.
According the NCI, breast cancer is the second most common type of cancer in women in the U.S.
"Women with fatty breast also develop breast cancer, so it can happen in everyone and I think the key is to know what your risks are, to talk to your doctor about those risks, to see, you know, are you one of those women who should get a yearly ultrasound, or an ultrasound every six months or an MRI,” said Zakris.
For some families the affordability of extra screenings could be a concern. Still medical professionals say there are resources to help people.
"With the Susan Komen funds that are available and the American Cancer Society also hopefully there are funds out there that help,” Lauve said.
But fear prevents some women from getting any screenings.
"I see patients every single day who have a lump for two to three years and don't, they're afraid to go to a doctor or they don't get breast imaging because they're afraid to go to their doctor and I wish I could do something to you know take away that fear in women because early diagnosis is the key,” Zakris stated.
Lauve urges women to make screenings a priority.
"Because it's so much better staged at an early stage…I’m doing great, almost two years cancer-free,” she said.
The public has until June 26, 2019 to make comments on the FDA’s proposed density reporting rule.
Electronic submissions can be made at: https://www.federalregister.gov/documents/2019/03/28/2019-05803/mammography-quality-standards-act