Breast density describes the amount of fibrous and glandular tissue compared with fatty tissue in your breasts. It is determined by how your breast tissue looks on a mammogram, not by how your breasts look or feel. Breast density is very common and having dense breasts does not mean that something is wrong. Breast density can also change over time.
Mammogram reports describe breast density using four categories:
A: Almost entirely fatty
B: Scattered areas of dense tissue
C: Heterogeneously dense
D: Extremely dense
Categories C and D are considered “dense breasts.”
Breast density matters for two reasons. First, dense breast tissue can make breast cancer more difficult to see on a mammogram because both dense tissue and many breast cancers appear white on mammography.
Second, having dense breast tissue is itself associated with an increased risk of developing breast cancer. Breast density is only one part of your overall risk, however, and should be considered along with your age, family history, previous breast biopsies, genetic factors, and other health history.
If your mammogram shows dense breast tissue (category C or D), I generally offer the option of supplemental breast screening in addition to your regular mammogram.
Supplemental screening is optional. Having dense breasts does not mean that you need additional imaging or that something is wrong. Mammography remains the primary breast cancer screening test, and you should continue your regular mammograms even if you choose additional screening.
The potential benefit of supplemental screening is that it may detect some breast cancers that can be more difficult to see on a mammogram because of dense breast tissue. The tradeoff is that additional imaging can also identify benign findings, which may lead to additional imaging, follow-up, or occasionally a biopsy.
There isn't one right choice for everyone. If you have dense breast tissue, we can discuss the benefits and limitations of supplemental screening and decide whether it is something you would like to pursue.
When supplemental screening is used, it can be helpful to space it between annual mammograms, rather than having both studies performed at the same time. This can provide an additional opportunity to evaluate the breasts between routine mammograms.
If you are having your supplemental screening through Novant Health, it must be completed within 6 months of your most recent mammogram. If you would like supplemental screening, I generally recommend scheduling it several months after your mammogram when possible, while still making sure it is completed within this 6-month scheduling window.
If you choose supplemental screening, you would generally choose ONE of the options below. These tests are performed in addition to, not instead of, your yearly mammogram.
Breast MRI provides very detailed images of the breast and is the most sensitive supplemental screening option. It does not use radiation, but it does require an IV contrast medication.
The biggest limitation is often insurance coverage and cost. Coverage may be more likely for patients with extremely dense breast tissue or additional breast cancer risk factors, such as a strong family history. If you're interested in MRI, you may want to contact your insurance company before scheduling to ask about your expected out-of-pocket cost. Novant also identifies extremely dense breasts and high-risk histories among circumstances in which breast MRI may be recommended.
For insurance questions:
CPT: 77049 – bilateral breast MRI with and without contrast
Diagnosis: R92.333 – heterogeneously dense bilateral breasts (Category C)
Diagnosis: R92.343 – extremely dense bilateral breasts (Category D)
Insurance coverage varies, and providing these codes does not guarantee coverage. Your insurance company may also consider other diagnoses or risk factors when determining eligibility.
Whole-breast ultrasound is often a more practical supplemental screening option for patients with dense breasts. It uses sound waves rather than radiation and looks at the breast using a different imaging method than mammography.
Ultrasound may detect some findings that are more difficult to see within dense tissue on a mammogram. It is generally less sensitive than breast MRI, but may be less expensive and more likely to be covered by some insurance plans. It can also identify benign findings that lead to additional imaging or biopsy.
For insurance questions:
CPT: 76641 – complete breast ultrasound, per breast
Diagnosis: R92.333 – heterogeneously dense bilateral breasts (Category C)
Diagnosis: R92.343 – extremely dense bilateral breasts (Category D)
Coverage varies by insurance plan, so I recommend confirming your individual benefits before scheduling.
Abbreviated breast MRI is a shorter version of a traditional breast MRI that uses fewer images while still providing supplemental screening with MRI. Like a full breast MRI, it does not replace your annual mammogram. Novant specifically offers abbreviated screening breast MRI for patients with dense breast tissue.
This is typically offered as a self-pay option and may be a good choice for patients who would like the additional sensitivity of MRI but do not have insurance coverage for a traditional screening breast MRI. The cost is often around $400, although pricing can change, so I recommend confirming the current price when scheduling.