RANZCR’s Updated Breast Density Position Statement - Why Reporting Matters

This article aims to inform and advocate for the updated breast density position to our members. It highlights the importance of reporting breast density in both screening and diagnostic settings, and how it contributes to better breast cancer detection and patient outcomes.

In December 2023, the Royal Australian and New Zealand College of Radiologists (RANZCR) updated its position on breast density, emphasising the importance of mandating the reporting of breast density in both screening and diagnostic settings across Australia and New Zealand. This update aims to ensure that all women receive the most accurate information possible regarding their breast health, which is crucial for early detection and effective treatment of breast cancer.

What is Breast Density?

Breast density refers to the proportion of fibrous and glandular tissue in the breast compared to fatty tissue. On a mammogram, dense breast tissue appears white, making it more challenging to detect abnormalities or cancers, which also appear white. This can reduce the effectiveness of mammograms, particularly in women with high breast density.

Why is Reporting Breast Density Important?

1. Increased Risk of Breast Cancer: Women with higher breast density have a greater risk of developing breast cancer. Studies have shown that those with extremely dense breasts are at a 2.1-fold increased risk compared to women with lower density.
2. Reduced Sensitivity of Mammograms: Dense breast tissue can mask the presence of cancer, leading to an underdiagnosis. Standard 2D mammograms are less sensitive for detecting cancer in women with extremely dense breasts, with a sensitivity range of 57–71% compared to 81–93% for those with less dense, fibrofatty breasts.
3. Enhanced Patient Awareness: By mandating the reporting of breast density, women and their healthcare providers can have more informed discussions about additional screening options. This can lead to earlier detection and better outcomes.

RANZCR’s Recommendations

RANZCR supports the inclusion of breast density reporting in all mammographic assessments. This move aligns with the growing global recognition of the importance of breast density in breast cancer screening. In countries like the USA, it is already mandatory to report breast density in mammograms, and similar practices are being considered in Europe.

While acknowledging the challenges in adopting more advanced screening methods, such as breast MRI for women with extremely dense breasts, RANZCR is committed to working with governments and regulatory bodies to move towards this gold standard. In the meantime, mandating the reporting of breast density is a critical first step in enhancing breast cancer detection and treatment.

What This Means for You

For our members, this updated position statement underlines the importance of consistent and accurate reporting of breast density in both screening and diagnostic settings. It encourages you to:

• Educate patients about the implications of breast density on their screening results and overall breast cancer risk.
• Advocate for standardised reporting practices within your institutions to align with RANZCR’s recommendations.

By incorporating breast density reporting into routine practice, we can significantly improve the early detection of breast cancer and contribute to better outcomes for women across Australia and New Zealand.

RANZCR remains committed to supporting you in this transition and will continue to provide guidance to improve breast cancer screening and care. To read our position statement on Breast Density click here.