On the eve of Breast Cancer Awareness Month comes the news that Katie Couric, the former CBS Evening News anchor, was diagnosed with breast cancer in June this year. She missed a routine screening mammogram that should have been done about eight months into the pandemic. “I shudder to think what might have happened if I’d put it off any longer,” she wrote on social media, and continued: “I wanted to share my personal story with you all and encourage you to get screened and understand that you may fall into a category of women who needs more than a mammogram.”

One of those categories is dense breast tissue which affects more than 40% of women and can mask a cancerous tumour in a mammogram. This past Wednesday 28 September 2022 was recognised as World Dense Breast Day, an event sponsored by the educational website DenseBreast-info.org that aims to inform women and healthcare providers about the dangers posed by breast density. Writing for Diagnostic Imaging, Jeff Hall has contributed two stories that highlight the challenges of breast density and cancer risk.

In a longitudinal retrospective study of over 2.2 million Korean women who had no prior history of breast cancer, an increase in breast density over three consecutive biennial mammographic screenings led to significantly increased risk of breast cancer for both pre- and post-menopausal women. The research was published in Radiology, with one of the co-authors commenting, “Reductions in density among women with dense breasts could be achieved through increased breastfeeding and primary prevention with tamoxifen for women at the highest risk.”

In a meta-analysis published in The Breast, researchers from the Netherlands assessed data from almost 400,000 women and concluded that women with extremely dense breast tissue (BI-RADS category D) have more than double the risk for breast cancer in comparison to women with scattered fibro-glandular tissue (BI-RADS category B) and nearly four times the risk of women with fatty breast tissue (BI-RADS category A). Recognising that mammography has poor sensitivity for women with extremely dense breast tissue, the authors “strongly advise” screening with magnetic resonance imaging (MRI) for this higher risk population.

Given the publicity that has accompanied World Dense Breast Day, it seems reasonable to ask: Will these initiatives ultimately lead to earlier detection of breast cancer and the saving of lives? The jury is probably still out on this question but at least there is a growing recognition – among women and health professionals – that alternative imaging modalities such as ultrasound and MRI should be employed.