There are four basic types of breast patterns although every woman has her own unique mammographic pattern. No woman’s mammographic pattern looks like another woman’s mammographic pattern.
The first two mammograms on the left have more gray (fatty tissue) than white (glandular tissue) on the images. Mammography by itself is very sensitive in detecting a breast cancer. However, the two images on the right have just the opposite, more white than gray. With these two breast patterns, mammography can miss seeing 40-50% of breast cancers. This is because a breast cancer mass is white, so to see it on a mammogram, it is like trying to see a penny in a glass of milk. This compares with the first two images with so much the grey on the image, it is easier to see a white breast mass or analogous to seeing a penny in a glass of water. This is like trying to see a penny in a glass of water. So now you can understand why a negative mammogram with a dense mammographic pattern by itself is an insufficient for breast cancer screening because it can miss a lot of cancers.
Dr. Kamilia Kozlowski knew since the advent of modern day mammography in 1980 about the limitations of a dense mammographic pattern and its lower sensitivity at breast cancer detection. The Knoxville Comprehensive Breast Center has been doing screening breast ultrasounds since its establishment in 1983 well before it was recognized its invaluable contribution to evaluating a dense mammographic or questioned mass on mammography. The FDA that is responsible for the rules, regulations, and yearly inspections of mammographic facilities requires that a woman receive a letter in the mail which must report only one or two findings: the mammogram is negative or if there is a questioned finding that additional imaging is recommended. Connecticut was the first state in 2009 through the advocacy of Nancy Cappello, Ph.D. to pass a law that women who have a dense mammographic pattern on screening mammography must be informed by their primary care doctor of this fact and let women know that additional imaging might be advantageous to them. After three years of beginning the process in the Tennessee legislature by Dr. Kozlowski, the Tennessee Breast Density Law was signed by Governor Haslam in June of 2013 and enacted on January 1, 2014.
KCBC has always taken a proactive role in informing women who have a dense mammographic pattern that additional imaging such as breast ultrasound would be beneficial for their breast cancer screening.
Some women are aware that they have a dense mammographic pattern. They may already be patients of KCBC who have had a yearly mammogram and breast ultrasound exam as part of their wellness visit. These women know the limitations of a dense mammogram in detecting breast cancer or have been previously informed by another facility that they have a dense mammogram.