For the past 20 years, Vicky Tennant has followed official advice and had a mammogram every two years.
Now in her 70s, the Sydney woman believed she was doing everything she could to watch out for breast cancer.
So when a suspicious lump was discovered, she was shocked to also find out she had dense breasts and therefore was at higher risk of the disease.
“I would have certainly wanted to know what that meant and … what I possibly needed to do differently,” she said.
Breast density refers to the amount of fibrous and glandular tissue versus the amount of fatty tissue.
BreastScreen Australia is the national screening program, jointly funded by the federal, state and territory governments, to provide free mammograms through state-run services.
The national body’s policy is not to record participants’ breast density, nor report it to them.
Vicky Durston, director of policy at the Breast Cancer Network of Australia, said that needed to change.
“Reporting of breast density empowers women … to make informed decisions that are right for them,” she said.
Risk assessment
Women with dense breasts are at greater risk of cancer and cancer can also be harder to detect in dense breasts.
That’s exactly what happened to Ms Tennant.
A mammogram detected a tumour in one of her breasts but failed to show she also had cancer on the other side.
That tumour was only found because when Ms Tennant went back to the service for further investigation, she was offered an ultrasound.
“It wouldn’t have been found for another couple of years, even then maybe not,” she said.
Mary Rickard, radiologist at the Sydney Breast Clinic, said screening services should tell women their breast density because regular mammographic screening may not detect tumours in dense breasts.
She said those women might need additional imaging such as an ultrasound to detect cancer.
Professor Rickard was instrumental in establishing Australia’s breast screen program and said mammography was highly effective at detecting early cancer.
She said she wanted women to know, however, that mammogram reports were not equally accurate.
“A woman who’s got low density breasts … has a very good chance that’s a totally accurate report,” she said.
“If she goes in with high density breasts, there is a significant risk that her cancer might be missed.”
Different states, different policy
Western Australia’s breast screen program has been reporting breast density for over a decade.
South Australia started doing it in 2023 and Victoria is currently rolling it out.
In 2020, a government-appointed group of medical specialists recommended BreastScreen Australia not routinely record breast density or provide supplementary testing for women with dense breasts.
“There is no agreed consistent and reliable way to measure density or consensus on how to optimally manage breast density,” their position statement said.
A spokesperson for the Department of Health and Aged Care said that position was currently under review as part of a broader evaluation of BreastScreen Australia, expected by early to mid 2025.
Ms Durston has called on the government to prioritise changing its policy on reporting breast density and said women had a right to know their cancer risk.
She wants nationally consistent guidance on what action women with dense breasts should take.
“What we also want to see is the education and support for GPs of how to manage that information and concrete guidance as to what supplementary strategies look like,” Ms Durston said.
Individualised medicine
Profesor Rickard said one of the issues with the BreastScreen program was that it took a one-size-fits-all approach to diagnosis.
“We’re not doing anything to individualise it,” she said.
Professor Rickard said she also wanted screening services to inform women about their breast density.
“We’re all entitled to know as much about our health as the doctor knows about our health,” she said.
Since 2023, the Royal Australian and New Zealand College of Radiologists has said additional imaging tools such as ultrasound, contrast enhanced mammography and MRIs can detect cancers that would otherwise be missed in women with dense breasts.
The US Food and Drug Administration adopted a policy in 2023 of requiring breast density reporting.
The European Society of Breast Imaging recommends women with dense breasts have a breast MRI every two to four years, in addition to mammography.
“We are certainly behind international standards on reporting on breast density,” Ms Durston said.
Ms Tennant now believes she should have been having annual checks, or a mammogram and ultrasound.
She was shocked to discover the screening service she relied on had information about her breast cancer risk that it had not shared with her.
“That information is actually there and it is important and women need to know,” she said.
