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- RE: Breast density disclosure may do more harm than good
January 13, 2020
To the CMAJ Editor,
I read the recent article on Breast density disclosure with disbelief and concern. I am a family doctor in BC and in 2015, when 43yrs old, I was diagnosed with breast cancer after palpating a large lump in my left breast. My only risk factors for breast cancer were being female and having dense breasts. However, I did not know my breasts were dense at the time of my diagnosis because this information was never shared with me. If I had known that my breasts were extremely dense, I would not have allowed a normal mammogram to reassure my physician and delay my breast cancer diagnosis by three months.
Women have the right to know their breast density. They have a right to know their breast cancer risks and how sensitive a mammogram is for them. They have the right to make informed decisions about breast cancer screening and their own health. To reason that disclosing ones breast density should be avoided to prevent unnecessary anxiety is unethical and paternalistic.
I was involved in the establishment of a breast health clinic in our community in 2017. We see over 300 patients monthly at the clinic. All patients are informed of their breast density and given information on what it means. Not one patient has ever told me that knowing her breast density has made her more anxious. Instead, we are routinely thanked for taking the time to share and explain this information. Every patient seen at the cl...
Show MoreCompeting Interests: None declared. - RE: Breast density disclosure may do more harm than good
Re: Breast density disclosure may do more harm than good by Laura Eggertson
Ms. Eggertson, in her article got a few things right, but several things wrong. She correctly communicated the double-barreled risk associated with breast density. It is important for women and their healthcare providers to know when an individual is at increased risk of developing breast cancer. It is even more important that they be informed when there is increased likelihood of an already existing cancer being missed on a mammography screen because it is hidden by dense breast tissue. A woman with breast cancer who receives false reassurance of a negative examination is at risk of delayed, and in some cases, more harmful treatment once the cancer is found.
My concerns about this article, begin with its title. Of course any activity can cause more harm than good if it is not done properly. But, why shouldn’t communication of breast density be done properly? And while the push to communicate information on density came from advocacy, there is plenty of solid and well reproduced quantitative peer-reviewed evidence to support the existence of those two risk factors.
Ms Eggertson's article states that there are no definitive studies demonstrating that giving women information on their breast density will reduce breast cancer incidence. I don’t think that anybody has suggested that this would occur. Density is associated with breast cancer risk, but reducing density doesn’t...
Show MoreCompeting Interests: Martin Yaffe is a breast cancer researcher. His institution conducts collaborative research with GE Healthcare on topics related to breast cancer imaging. He receives no personal remuneration in that collaboration. Dr. Yaffe also is a shareholder in Volpara Health Technologies (NZ), a company whose products includes software for measuring breast density. - RE: Breast density disclosure may do more harm than good
Editor,
I was shocked to read Laura Eggertson’s article on Breast Density Disclosure in the latest CMAJ Newsletter, and concerned for the misinformation to Canada’s family doctors, which will ultimately harm their patients.Citing unnecessary anxiety as a reason to withhold important health information is patronizing. Dense breasts are associated with 2 important risks as outlined in the article: the risk that cancer will be masked on the mammogram and the increased risk of getting breast cancer. Mammograms miss over 50% of cancers in women with the densest breasts, so offering them only mammography for breast cancer screening is discriminatory1. Women with dense breasts deserve the same opportunity for early detection of breast cancer, as women with non-dense breasts.
Large scale supplemental screening with ultrasound in Connecticut (the first state to mandate density notification) shows 3-4 cancers per thousand women screened2, and these ultrasound-detected cancers are almost all small, invasive and node negative3. NOT DCIS, which arguably may be “overdiagnosed.”
If those cancers go undetected, they grow until they are detected by palpation, as “interval cancers,” which are larger at diagnosis and more often node-positive than screen-detected cancers. They tend to be higher nuclear grade, and more aggressive with a greater predominance of HER2 and triple negative molecular subtypes. They have a poorer prognosis compared to screen-detected canc...
Show MoreCompeting Interests: Volunteer Advisor: Dense Breasts Canada and www.denebreast-info.org Stockholder, Volpara Solutions