Contributed by: Katherine E. Dee, MD - June 1, 2002
What is the breast density of this screening mammogram?
Almost entirely fat Scattered glandular densities Heterogeneously dense Extremely dense
The breasts are heterogeneously dense, which may lower the sensitivity of mammography
A sentence about the overall breast density should appear in the body of each report. This conveys some sense of the sensitivity of mammography to detect cancer in the individual patient. Overall the sensitivity decreases with increasing breast density.
This is the patient’s mammogram 1 year prior:
What is the most likely explanation for the changes?
About 20% of patients on HRT show some increased density at mammography. Not all cases are this pronounced. Pregnancy can also cause such an effect, although most patients of screening age are more likely undergoing HRT.
Menopause usually leads to fatty replacement of the breasts. Mastitis may cause increased density but is usually unilateral, and is often associated with skin thickening. PLUS, patients with mastitis are usually symptomatic. Since this was a screening mammogram, the patient should be asymptomatic. Finally, an estrogen-producting tumor elsewhere in the body would be exceedingly rare.