For decades, October has served as the month of national recognition for breast cancer awareness. During this time, mortality rates for breast cancer have decreased significantly, namely due to increases in early detection and improved treatments.
Yet despite these efforts, breast cancer remains the second leading cause of death among women in the United States.
Today, an estimated 1 in 8 women will be diagnosed with breast cancer within their lifetime, and 44,000 women are expected to die of the disease this year. Notably, although white women are diagnosed at slightly higher rates, Black women are 40% more likely to die.
One of the many issues that continues to stymie progress on reducing late-stage diagnosis associated with increased mortality is the lack of awareness of breast tissue density.
While nearly 70% of women over the age of 40 report getting a standard screening mammogram within the past two years, not all may be aware that about half of women have more dense breast tissue, a type of tissue that can make standard screening mammograms more difficult to read by radiologists.
Breast density refers to the ratio of tissue to fat in the breast. This is broadly categorized as ranging from breasts composed almost entirely of fat, to breasts that are considered to be extremely dense with more than 75% tissue.
As tissue will appear more white on a standard screening mammogram, versus fat which shows up as black, it is more likely to obscure the identification of cancer as cancer also appears white on a mammogram.
According to the Women’s Imaging Center, Colorado women in particular may be more likely to have dense breast tissue. This is due to a variety of factors involved in a healthier than average lifestyle and lower average age.
For women with dense breasts, there are options for additional screenings if needed that include whole breast ultrasound or Magnetic Resonance Imaging.
In many ways, Colorado is ahead of the curve. In 2017, the Breast Density Notification Law was passed by sponsors Sen. Angela WIlliams and Rep. Jessie Danielson.
Coupled with updates in 2019, Coloradans are now mandated to receive notice if they have dense breasts, as well as mandated coverage by insurance without cost-sharing for additional screenings, including those coded as diagnostic if recommended by a physician.
This law is in stark contrast to national policy where there remains no mandated screening coverage or requirement for patient awareness of breast density.
Despite the latter being ordered by Congress in 2019, the Food and Drug Administration has lagged on enacting the national standard. Even still, the rule would not enact nationally mandated coverage.
In light of lagging national policy, there is even more work that can be done in Colorado. According to one advocacy group for dense breasts, the state still has no mandate on the disclosure of breast density category, only notification, as well as no mandate for providing radiology information of the masking effect of dense breasts on mammograms. Both could easily be updated in the next legislative session.
There also remain barriers to access, especially for uninsured women. Although the Affordable Care Act protects people from paying out-of-pocket costs for standard mammography, there is no such protection for additional screenings, particularly as these tests are generally coded as diagnostic.
Therefore, women who require additional screenings and are forced to pay out-of-pocket can garner a hefty price tag ranging into the hundreds to even thousands of dollars. Such barriers to access reduce cancer screenings over time and increase mortality rates, as women forced to pay out-of-pocket costs are less likely to get subsequent screenings.
We have come a long way in the fight against breast cancer, but we still have a long way to go. Further efforts to increase patient awareness and advocacy for factors that impact early detection, such as breast density, is one way that we can work together to further reduce the impact of breast cancer.
Trish Zornio is a scientist, lecturer and writer who has worked at some of the nation’s top universities and hospitals. She’s an avid rock climber and was a 2020 candidate for the U.S. Senate in Colorado.
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