Why a Mammogram Isn't Always Enough to Rule Out Cancer

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For the nearly half of American women with dense breast tissue, a mammogram might not be enough to spot cancer early. The tangle of glands and connective tissue appears white on a mammogram. Tumors also appear white, so dense tissue can shield them from view.

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Nearly 40 states already require that women be notified about dense breast tissue. But there isn’t consensus on what to do with such results. Many doctors encourage women with dense tissue to consider additional tests including an ultrasound or MRI. Others say further tests could lead to unnecessary procedures. Some aren’t caught up on the trade-offs.

The U.S. Preventive Services Task Force, a government-backed group that sets guidance on screening and preventive care, says there isn’t enough evidence to recommend more testing. And insurance coverage for ultrasounds or MRIs varies by state and insurer.

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Ultrasounds catch roughly two more cancers per 1,000 women with dense breast tissue compared with mammograms alone. MRIs are even more sensitive. A 2019 study found a detection rate as high as 16 cancers per 1,000 women with extremely dense breast tissue. The women who got MRIs also were diagnosed with fewer cancers between regular screenings, suggesting those that developed were caught earlier.

But there isn’t evidence from large clinical trials to show the tests reduce breast-cancer deaths for women with dense tissue, an important consideration for medical groups that set recommendations. Regular mammograms reduce deaths from breast cancer, studies show.

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