Breast cancer screenings: An expert discusses why tissue density matters
Dr. Alia Abdulla, a breast surgeon who works with the Broward Health Physician Group, recommends patients with high breast density get an additional test.
Nearly half of American women 40 and older have dense breast tissue, making it harder for doctors to detect cancer, according to the National Cancer Institute.
Having high breast density can make screenings more difficult to interpret because dense breast tissue and tumors both look white on mammograms, whereas fatty tissue appears as a dark area.
Dr. Alia Abdulla, a breast surgeon who works with the Broward Health Physician Group, recommends patients with high breast density get an additional screening test.
“In patients that have dense breasts, it's important to also utilize ultrasound for the identification of changes in the breast,” Dr. Abdulla said.
This month, as part of Breast Cancer Awareness Month, first lady Jill Biden is urging women to consult their doctors about getting mammograms or other cancer screenings, saying in a new public service announcement that early detection saves lives.
Breast cancer is the second most common cancer in U.S. women after skin cancer, according to the Centers for Disease Control and Prevention. Breast cancer deaths have declined over time but remain the second leading cause of cancer death among women overall, the CDC said. One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime.
Broward County’s rate of advanced breast cancer cases in women was 34.3% in 2020, higher than Florida’s overall rate of 30.9%, according to the latest data from the Florida Department of Health.
WLRN’s Ammy Sanchez spoke with Abdulla about breast cancer screenings. The conversation was edited for length and clarity.
WLRN: What factors need to be present that would necessitate an ultrasound, and how much does that vary?
ABDULLA: In general, in order for you to benefit from an ultrasound, you would have to have dense breasts on [a] mammogram. There we grade the mammogram in four categories of how dense a breast may be. In any breast that is category three or four ... those are the patients that we typically add ultrasound as a needed study to monitor for breast cancer in addition to mammograms.
Most insurers routinely cover the full cost of annual mammograms as preventive care, but patients are often required to pay out of pocket or through a co-pay to get an ultrasound done. Considering that not everyone can afford that, what would you recommend patients do in those situations?
In general, as a physician and as a surgeon, when my patient requires an ultrasound, we typically do order the ultrasound and it usually gets covered. But it depends on the insurance in terms of what your deductible might be, as to how much your contribution for that study might be. And so I think it's a little bit of a complicated idea that it's not being covered. It isn't that it's not covered. It's just that it depends on your insurance in terms of your deductible.
Are there any other screenings available that people would be able to get if they cannot pay out of pocket and co-pay is not an option for them?
Unfortunately, no, because an MRI would be more expensive and even a contrast-to-mammogram would also be an additional charge because it is an additional mammogram. And so there are no other studies that would substitute for the breast ultrasound. [But] at Broward Health, we do have certain programs, including funding from the county and other organizations that could assist in helping certain patients. It does depend on certain factors. But in cases where patients can't afford certain studies, we do try to provide funding assistance... So I would encourage you to contact your doctor and see if there [are] any programs that you would qualify for.
Broward County’s rate of advanced breast cancer exceeds the state and national average. Is there any evidence or research that suggests a cause as to why women in Broward County specifically are developing breast cancer at such high rates?
Unfortunately, we have been affected by COVID. COVID did cause a lot of delays in screening mammography in general. At this point in time, Broward County is suffering from a higher rate of breast cancer. But I also know that we had suffered from a decrease in the amount of screening tests that patients completed for the last two to three years. I do think that this has affected the rates and it has increased the amount of patients that now we are identifying with breast cancer in general. I would encourage any patient to go to their doctor to obtain their screening mammogram.
What aren't people talking about? What is missing from the conversation about breast cancer prevention and awareness?
I do think that in general people need to have a focus on nutrition. In general, the risk factors that affect breast cancer surround estrogen exposure, and there is exogenous estrogen in our diets that we may not know about. There is exogenous estrogen in hormonal replacement therapy. In general, hormonal replacement therapy used to be very common. And now we know that it does increase your risk of breast cancer. So there are many women [who] do not take it. However, there are still many women [who] take exogenous estrogen as they approach menopause. And I think that education on this and education on other estrogen sources in our diet, which includes soy products, is important to understand our risk of developing breast cancer. If a patient has a risk of developing breast cancer because they have a significant family history or because they have a gene mutation, they should be more careful with their diets and their environmental exposures.
Copyright 2023 WLRN 91.3 FM. To see more, visit WLRN 91.3 FM.