A quantitative future
Masking tumors on mammograms is only one of the risks that dense tissue poses. The very presence of dense breast tissue indicates that a woman is at greater risk of developing breast cancer.

Dr. Conant believes that the most accurate and reproducible way to measure breast density is using quantitative measures rather than more subjective or potentially variable qualitative assessments. “There’s a big move to have breast density or “complexity” measured quantitatively with robust and reproducible computer algorithms. These quantitative measures can help us better understand why some cancers aren’t detected with mammography alone, while also providing insight into cancer subtypes and breast cancer risk. We believe this image data will better inform radiologists and healthcare providers which screening test or tests are best for an individual woman.”

Dr. Saini echoes this sentiment, adding that the density-cancer link and limitations in mammography must be taught to a greater extent in medical schools, and that models such as BI-RADS can only truly reflect the best approach for detecting cancer once standardization is in place.

“Having every state do a different thing creates more confusion,” she said. “We have to have a national, uniform conversation, which means it’s going to be probably at the level of the FDA to mandate a uniform approach to this. If we have an automated standardized way of assessing density across our population and the world, then we can track who are the women at greater risk.”

She does, however, note that research for new technologies in this area are on the rise and will help to relieve not just the challenges of breast density assessment and cancer detection but other burdens, such as the increasing shortage of radiologists worldwide.

Experts agree that awareness is growing, as evidenced by the more than 30 states with mammography laws, and that further growth must be facilitated by all parties, from legislatures and medical practitioners to manufacturers and patients.

“Manufacturers must demonstrate more that their products are cost-effective and improve clinical outcomes,” Abdolell said. “They can do this by providing the opportunities to validate their technologies to support researchers and breast imaging centers. Patients, too, need to take more ownership of being aware of their health because of the structure of payers and insurers. They have to be self-advocates. That’s how it moves into the realm of legislation.”

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