Canadian radiologist presents findings to the Radiological Society of North America

“The radiologist wants a follow-up mammogram in six months,” your doctor tells you.

You’ve heard and seen all the TV and Radio ads about 1 in 8 women getting breast cancer. So, you’ve been good–you got screened. Now you have to do it all over again?

As it turns out, the mammogram is difficult to interpret due to “dense glandular tissue,” a very common finding in younger women or those on HRT.

And that’s when you realize that not knowing whether you have a tumor or not is one of the most trying experiences of your life.

You don’t have a tumor, but you know lots of women get breast cancer. You’re scared but as far as anyone can tell there really is nothing wrong with you, so why talk to anyone about it? It’s enough to make you a nervous wreck.

Your doctor reassures you, quoting statistics about screening and telling you that “this is just a standard practice–there is no indication of tumor.” But somehow the prospect of bad news lingers in the back of your mind.

Doctors know that repeated mammography may pose a risk of cumulative radiation exposure, yet the risks of missing a tumor far outweigh this. But now there is a way to reduce the number of mammograms some women receive due to dense glandular tissue.

And a more definitive answer to “that question” may make quite a few patients feel much better.

Why is “dense glandular tissue” a problem? Conventional x-rays (a mammogram is a low-radation x-ray) are not the best way to view soft tissue changes. It is ironic that x-rays are used to diagnose breast cancer because a small tumor inside dense glandular tissue cannot be seen.

This is why you may see radiologists constantly and tediously poring over mammograms with magnifying glasses. They do their best not to miss anything.

If there is a finding of “dense glandular tissue” and the radiologist cannot rule out a tumor (she can’t rule out what she can’t see) the best course in the past has been to follow the patient with a repeat mammogram in 6 months, usually, or sometimes 12 months so the radiologist can compare the series of mammograms to see if there any changes.

A recent study of 196 women shows that MRI (Magnetic Resonance Imaging) can be used to rule out suspicious-looking mammograms. The benefit to the patient is that she doesn’t have to worry for 6 months, waiting for her “follow-up.”

One of the big pay-offs of using MRI is that there is no radiation used in the procedure. MRI uses radio-frequency magnetic pulses that have not yet been demonstrated to have any ill effects. In addition, MRI is considered much better than other radiographic procedures in imaging soft tissue such as fat, glands, muscle and ligaments.

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