The Importance of Breast Tissue Density on Risk Assessment Models

Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue The Importance of Breast Tissue Density Objective 1 Objective 1 Objective 1 Objective 1 Objective 4 Objective 4 Objective 4 Objective 4 Objective 4 Objective 2 Objective 2 Objective 2 Objective 2 Objective 2 Objective 3 Objective 3 Objective 3 Objective 3 Objective 3 Select each button to learn more. Importance of Breast Tissue Density on Risk Assessment Models Welcome & Objectives Welcome to the Importance of Breast Tissue Density on Risk Assessment Models Online training. This training will delve into the critical aspects of breast tissue density and its pivotal role in risk assessment models. We will explore not only the significance of breast tissue density but also the imperative need to educate patients about it. This online training aims to equip mammography techs, who are at the forefront of breast health, with comprehensive insights into this crucial topic. objective one: Understand the significance of breast tissue density in breast cancer risk assessment models. Objective two: Explore the implications of breast tissue density on mammography and its role in improving risk assessment accuracy. Objective three: learn effective strategies for educating patients about the importance of breast tissue density in their breast health. Objective four: Gain practical skills for communicating complex information to patients with clarity and compassion in the context of breast tissue density. Objective four Gain practical skills for communicating complex information to patients with clarity and compassion in the context of breast tissue density. 4 4 4 4 Developers – second color option for image/content. align all objectives to be the same Image ratio/placement Objective three Learn effective strategies for educating patients about the importance of breast tissue density in their breast health. 3 3 3 3 Developers – second color option for image/content. align all objectives to be the same Objective two Explore the implications of breast tissue density on mammography and its role in improving risk assessment accuracy. 2 2 2 2 Developers – secod color option for image/content. align all objectives to be th same Objective One Understand the significance of breast tissue density in breast cancer risk assessment models. 1 1 1 1 Developers – first color option for image/content. align all objectives to be the same Table with 2 columns and 4 rows Not all pages contain audio. Some pages invite you to read for yourself or watch a video. All pages show a ? button in the lower-right corner. Select the ? button to get a quick guide through the navigation elements. Select the button on the left upper corner to display or hide the menu. ? Navigation Hints Before you start, we would like to give you a few tips on how to navigate: Enjoy the course! Select the X to close the pop-up. Click Next to continue. ? Navigation Hints Untitled Slide What makes up breast tissue? Text Fibrous Tissue Glandular Tissue Fatty Tissue What makes up breast tissue? Starting with the basics, what makes up breast tissue? First, fibrous tissue, also referred to as connective tissue. Next, glandular tissue, thinking more the lobes and the ducts, kind of the meat of the breast. And then we have fatty tissue, which gives the breast its size and its shape. Breast tissue density The American College of Radiology requires the interpreting radiologist to categorize breast tissue density into one of four categories under the BI-RAD system. Fatty breasts: 10% Scattered: 40% Heterogeneously dense: 40% Extremely dense: 10% Breast tissue density Everyone has varying amounts of each of these tissues. When a breast has more of the fibrous and glandular tissue, that is what makes a dense breast. The American College of Radiology requires the interpreting radiologist to categorize breast tissue density into one of four categories, under the BI-RADS system. First, fatty breast, this makes up 10% of women that will have fatty tissue. Next, scattered tissue, about 40% of women are going to have scattered tissue. The fibro glandular tissue is starting to creep into the breast. For the most part, we can still see the fatty tissue. Things are going to pop out still in that breast. Moving into heterogeneously dense, 40% of women will fall into this category. With tomo, we can scan through, see different angles, getting more information. And lastly, about 10% of women will present with extremely dense breast. Tomo is going to help a lot with the dense tissue. Distribution of BI-RADS Breast Density Categories BI-RADS breast density categories This chart is based on the BI-RADS system broken down into categories by age. 43.3% of women are going to stay in the scattered and heterogeneously dense categories, while scattered and fibroglandular densities are going to increase. As we age, that dense tissue is going to be replaced by fatty tissue. But these women are never making it to extremely fatty, they will fall into scattered and fibroglandular. How does this affect cancer diagnosis? A small cancer in a fatty breast can easily be seen. BUT, even a large cancer in a dense breast can be difficult to spot. How does this affect cancer diagnosis How does the density of breast tissue affect cancer diagnosis? A small cancer can be easily seen in the fatty breast. Moving into the dense category. If that circle is not there, it's going to be hard to see. 3D is going to provide more information. But even the cancer seen here, is about four times the size of the small cancer, and it is still difficult to see due to the density of the breast. We want to be able to see the changes every single year. Supplementary tools like such as M-R-I, and ultrasound will only be of benefit to these patients. These additional imaging modalities are going to provide more information about the breast tissue. This will be discussed in more detail in upcoming slides. Other risk factors to consider Dense breasts are not the only risk factor for breast cancer. 80% of women diagnosed with breast cancer are 50 years of age or older. Genetic changes BRCA 1 and BRCA 2 gene mutations Sedentary lifestyle characteristics overweight, alcohol consumption, smoking Hormone therapy elevated levels of progesterone and estrogen Reproductive history first menstrual cycle age, how many pregnancies, first live birth after age of 30? Previous breast cancer diagnosis BI-RADS breast density categories Dense breast tissue is not the only risk factor. Eighty percent of women diagnosed with breast cancer are 50 years or older. Genetic Changes: BRCA 1 and BRCA 2 gene mutations will increase the chance of breast cancer. Sedentary lifestyle characteristics: such as being overweight, alcohol consumption, and smoking. Hormone therapy: Elevated levels of progesterone and estrogen can be a sign of an abnormal growth of cells. Reproductive history. When was their first menstrual cycle, how many pregnancies, was the first live birth after 30? Previous breast cancer diagnosis is an increased risk, as you can be diagnosed again. What contributes to dense tissue? Age Genetics Race & ethnicity Hormone replacement therapy First live birth after 30 Low body mass index Menopausal status What contributes to dense tissue? Next, we will discuss what contributes to dense tissue. Age, a majority of younger women have dense breast tissue. As women age, the dense tissue is replaced by fatty tissue. Genetics, if Mom and Grandma have dense tissue, you may have dense tissue too. Race and ethnicity, 60% of Asian women will have dense breasts, followed by Hispanic and Latino women around 45%, and then 37% of African American women Elevated estrogen and progesterone increase the chance of breast dense tissue. A first live birth after the age of 30. Lastly, Low body mass index and menopausal status. ? Risk-based breast cancer screening: Implications of breast density Select the numbered steps below to review some research and investigate the impact of breast tissue density and the patient’s risk of developing breast cancer. 1 1 1 2 2 2 3 3 3 Changes in 2011 This chart comes from a Canadian screening study. Women with no previous cancer history, taking the risk assessment models. Breast density falls right below family history. Not all women have a family history of breast cancer. On the list we also have secondary relatives, heterogeneously dense breast and oral contraceptive use. Never having children and the age of first live birth are risk factors as well. FDA approved digital breast tomosynthesis Patient advocacy groups pushed U.S. legislation to require radiology facilities to disclose patient breast density. Many of which also provide additional language about supplemental screenings. 2023 – MQSA new guidelines 3 Changes in 2011 Canadian screening study Increased breast density: 16% of all breast cancers 40% of interval cancers 12% of screen detected cancers 2 Relative risks of developing breast cancer for women age 40-49 1 Table with 2 columns and 2 rows Risk Factor Breast Cancer Risk Ratio (95% CI) Two 1st degree relatives with breast cancer 1st degree relative with breast cancer at age 1st degree relative with breast cancer at age One 1st degree relative with breast cancer Extremely dense breasts on mammography Prior benign breast biopsy 2nd degree relative with breast cancer Heterogeneously dense breasts on mammography Current oral contraceptive use Nulliparity Age of first birth at or above 30 years 3.84 (2.37 - 6.22) 3.0 (1.8 - 4.9) 2.17 (1.86 - 2.53) 2.14 (1.92 - 2.38 2.04 (1.84 - 2.26) 1.87 (1.64 - 2.13) 1.7 (1.4 - 2.0) 1.62 (1.51 - 1.75) 1.30 (1.13 - 1.49) 1.25 (1.08 - 1.46) 1.20 (1.02 - 1.42) Select the to close the pop-up. ? Risk assessment models Select the tab arrows to learn more about the different types of risk assessment models. Overview The Tyrer-Cuzick model Kaiser Permanente study Graph data Conclusion Risk assessment models base layer – Select the tab arrows to learn more about the different types of risk assessment models. L1 - overview Here is an overview of risk assessment models. All of these have the same general requirements: age of patient, age when they had their first period, first lyve birth, any previous breast biopsies, and family history. As we move along, there is going to be more detailed risk assessment models. The Tyrer-Cuzick model gives more detail than the Gail model. The Tyrer-Cuzick model provides physicians with that extra information to determine if a patient is eligible for the supplementary screenings and preventative therapies. Although it has been reported that some mammograms have missed some breast cancers, mammography is still going to be the gold standard. Layer 2 TC Model The Tyrer-Cuzick (TC) model will identify women in high risk categories. It allows the breast density to be added as a factor in the model. L3 – Kaiser study: It is important to consider other screening options when a patient has dense breast tissue, or is at higher risk. Over the span of 19 years, The Kaiser Permanente Washington Study took women ages 40 to 73 with no previous breast cancer diagnosis. They looked at their screening mammogram and TC model. Then they incorporated breast tissue density based on the BIRADs system. The TC model showed women in the high risk category doubled after adding breast density. L4 – graph data This graph shows the straight line is kind of static, the objective. The bubble line above is with the breast tissue density incorporated. The numbers nearly doubled the number of women that can now be identified as high risk. Nearly double the women can now apply for insurance that may cover supplementary screening, such as MRI and ultrasound, to provide the physician more information on their breast tissue. L5 – conclusion In conclusion, The TC model is going to double the number of women that are now considered high risk, based on that breast tissue density. Conclusion Breast cancer risk assessment models combined with breast tissue density provide useful data for 10 years or more, and can be used to guide long term, systematic, risk adaptive screenings and prevention strategies TC graph data Objective: To document the accuracy of risk assessment model throughout a period of 19 years. Exposures: Risk factors from questionnaires given to patients based on TC model, and breast tissue density determined by their BI-RADS. Kaiser Permanente Washington Study 19 year study Women ages 40-73 No previous breast cancer diagnosis Screening mammograms January 1st. 1996 - December 31st, 2013 Follow up December 31st, 2014 Data analysis March 2nd, 2016 - November 13th, 2017 The TC Model Identifies few women in the general population to be high risk. However, when breast tissue density is considered, this allows for more high and low risk women to be identified. Overview of different risk assessment models Illustrate entry criteria for patients in prevention trials. Determine patients eligibility for supplementary screenings and preventative therapy. What did the study show? What did the study show? This chart is busy with a lot of numbers, but in short, The very top is just the TC score with nothing considered as far as breast tissue density. The Bottom is with the breast tissue density. So again, the numbers are nearly doubling for the high risk category of women and allowing more women to get supplemental screening examinations. Study proved importance of risk assessment models This study proved the importance of risk assessment models and the role they play in helping to provide the proper support to women through genetic counseling, preventative counseling, and supplementary screenings. In addition, being able to combine the TC model with breast tissue density nearly doubled the number of identified individuals in the high-risk category. Importance of risk assessment models So in conclusion, this TC model, when we consider breast tissue density is doubling the number of identified individuals into that high risk category, Hopefully applying that to our physicians, our OB GYNs and to counsel them as far as genetic testing goes, because that's important for these patients as well. It is important to be thinking about other preventative therapies, preventative counseling, and supplementary screenings. So research like this is what is needed to back that up. OK, Now we know somebody has dense breast, what can we do? ? Supplementary Screenings Select the tab arrows to learn more about the different options. Breast ultrasound Screening breast MRI Other options Contrast enhanced mammography Molecular breast imaging Supplemental screenings base layer A patient has been diagnosed with dense breast, so what happens next, what supplemental screenings can help? The two main supplementary screenings that are seen most often are breast MRI and breast ultrasound. Both will help aid the mammogram results for patient’s with dense breast. MRI can have high accuracy in tissue differentiation. It can increase the chance of having a biopsy, but the additional information will benefit the patients with dense breast. L1 – other options More options available are molecular breast imaging, and contrast enhanced spectral mammography. These are other options for patients who may not be able to get MRI, because of an implanted device or other reasons. L2 – ultrasound With Screening breast ultrasound, there are two main options: Handheld scanner, and automated whole breast ultrasound. Neither require radiation, and both methods are technologist dependent. automated whole breast ultrasound, or A-B-U-S, completes three sweeps of the whole breast. The Majority of facilities and outpatient centers are going to provide the handheld option. a few facilities may offer A-B-U-S. Both options are easily accessible and may require additional cost. As with any supplementary screening, it's going to depend on whether that patient has insurance coverage for these supplemental options. L3 – breast MRI MRI is a highly sensitive scan, and it does not require any radiation. There is also an option for contrast enhanced M-R-I. Breast M-R-I's can result in more false positives and can lead to more breast biopsies, but more women will be aware of what is hiding in the extremely dense breast tissue, even if it is something benign. MRI may not be easily accessible. There is also abbreviated breast MRI, this can be quicker and more cost effective. L4 – CE mammography A newer, more recent option is Contrast Enhanced Mammography. This Involves an injection of iodine based contrast during the mammogram. Staff must account for a reaction and have a crash cart available. The exam takes about 8-10 minutes. It is a quick exam and can be difficult if you have patients with mobility issues. There is an additional cost, and currently it is not widely available. There is also an additional radiation dose, potentially double. There is a low energy and high energy x-ray exposure. It is going to highlight those areas and ignore the dense tissue. L5 MI Molecular breast imaging, think about a nuc Med study. It has the potential to improve detection of breast cancer. The exam takes 10 minutes in each position, a total of approximately 40 minutes and less compression than a mammogram. it also Comes at an additional cost, and requires a radioactive tracer injection. this option with nuclear medicine is looking at the function of the tissue, as opposed to the structure of the tissue. this is about four times the radiation dose as a screening mammogram, but still under the guidelines. Still a lower dose compared to CT. Molecular breast imaging Potential to improve detection of cancer 10-minute scan in one position Additional cost Requires injection of radioactive tracer Increased radiation dose Contrast enhanced mammography Done at the time of mammogram Enhances dense breast tissue Aids in identifying concerning tissue Additional costs Not widely available Additional radiation dose Requires intravenous contrast injection Contrast enhanced spectral mammography Other options Molecular breast imaging Screening breast MRI Highly sensitive scan No ionizing radiation Additional costs Can result in more false-positives Not as easily accessible Screening breast ultrasound Handheld scanner ABUS Easily accessible No ionizing radiation Additional costs Technologist dependent How do we support our patients? Educate them: Inform patients on whether they have dense breast Relieve stress surrounding increased risk Provide next steps How do we support our patients? How do we support our patients? Again, educating them, and this is something that is as easy as taking just a couple minutes. After you are done with the exam, if your facility allows this, show the patient their pictures. Again, making sure we don't see anything popping out at us first, but bring them over to look at the images. explain that everyone has varying amounts of black and white tissue, and that if the images show more white than black, That is dense breast tissue. explain that when you have dense breasts, you may want to think about supplementary screenings. The best thing that you can do, is continue with annaul mammograms, But inform the patient there is also ultrasound and MRI. Encourage the patient to talk to their doctor the next time they have an appointment and ask them for a potential recommendation. As a technologists, At least we have done a little bit of a part that we can to educate them, So now they can keep it in mind for the future. explain that a Majority of women have dense breasts and they are not alone. reinforce the fact that it is really important to not miss having an annual screening. Even something as simple as saying we will see you next year. So, again, just important things to consider when talking with your patients. Common limitations Patient anxiety Fear of results Language barriers Fear of radiation exposure Bad experience in the past Common limitations Of course there are always going to be some limitations with some patients. Most times any patient coming in for a mammogram is going to be anxious. It is sometimes hard to keep this in the forefront of our minds as we are performing several mammograms a day on so many patients. Most are fearful of the results, even if they have had a normal result in the past. Language barriers can also be very difficult. Imagine having someone perform a mammogram who doesnt understand or speak the same language as the patient. That can be quite uncomfortable for both the technologist and the patient. There is also a fear of radiation exposure. With all the media and press putting out articles, but the patients hearing and seeing this do not know that they arent always very accurate with regards to radiation exposure. And lastly, if a patient has had a bad experience in the past getting a mammogram, this of course will cause anxiety, probably from the time of picking up the phone and making an appointment. So keeping all these things in mind and being sensitive to these limitations, can ease your patients mind by simply educating them and empathizing with their anxiety. Keep it simple! Provide excellent care throughout exam Be sure they know how to get their results Inform them what to look out for and what to do if they have a new concern Keep it simple So keeping it simple, providing excellent care, that is the number one thing we want to do for the patients. We want a good quality exam, and to get the best pictures possible. That is first and foremost important. Be sure the patient knows how to get the results. So many patients do not even know how to get their results. They will come in and say that they assume everything was fine last year because they never heard any different. we want to make sure we tell the patients how to get them because again, that little blurb about dense tissue may be on their results. So whether it's a phone call, portal message, e-mail, however the facility gets them the results, make sure they know before leaving how they are going to find them. Lastly, informing them what to look out for and what they should do if they have a new concern. This will show the patient that you really care about them and their breast health. What can your facility do? Provide Additional Information: Brochures Video links Group classes Posters/charts What can your facility do? In closing, What can your facility do to educate patients? By providing additional information using brochures, video links, group classes, and posters and charts. These brochures can be kept in the waiting room or given to the patient at the time of registration. Posters and charts can be placed in the dressing rooms, waiting rooms, even the bathrooms. It could prompt questions from the patients opening up the dialogue to have these conversations about dense breast. The more exposure the better. It is just as important to remember the role that we as technologists play in women's breast health. take that opportunity you have with patients and help educate them. ? Course Review Congratulations. You have completed the Importance of breast tissue density on risk assessment models Online Training. Select the numbered buttons below to review the material before proceeding to the final assessment. 1 1 1 Understand the significance of breast tissue density in breast cancer risk assessment models 3 3 3 Learn effective strategies for educating patients about the importance of breast tissue density 4 4 4 Gain practical skills for communicating complex information to patients with clarity and compassion 2 2 2 Explore the implications of breast tissue density on mammography Course Review Practical skills for communicating complex information with clarity and compassion ? Try not to cause alarm when informing them of dense breast tissue. Explain what it means, and that it is common. Speak slowly and concisely. Ask them if they have any questions. Be sure they know how to get their mammogram results. “We'll see you next year if nothing changes. If something does, go see your doctor and think about supplementary screenings. Ask your doctor about ultrasound or MRI and if they think that's a good idea for you.” Strategies for communicating to patients about the importance of breast tissue density ? Be empathetic and understanding of the patients anxiety level. Show the patient the images and inform them about their breast density and to open up a dialogue about the importance of understanding what this means to their breast health. Some will be more receptive than others to the information, and you have to gauge that with how much information you provide, and how you provide it. Implications of dense breast Having dense breast puts patients at a higher risk of developing breast cancer. Knowing that you have dense breasts brings a sense of self-awareness ensuring annual mammograms are performed prevention strategies potentially allows for the ability to have insurance pay for supplemental screening studies Increased breast density accounted for: 16% of all breast cancers 40% interval cancers 12% screen detected cancers Significance of breast tissue density This study proved the importance of risk assessment models and the role they play in helping to provide the proper support to women through genetic counseling, preventative counseling, and supplementary screenings. In addition, being able to combine the TC model with breast tissue density nearly doubled the number of identified individuals in the high-risk category. Disclaimer Please note that the learning material is for training purposes only. 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You will have 3 attempts to take this assessment and to successfully pass this course, you must receive a score of 80% or higher. You will receive your score when you have completed the assessment. Note: If you close the learning activity at any time before you have finished the quiz, your answers will not be saved. Select Start to begin. Start Assessment Fatty breast 10% Scattered 40% Heterogeneously dense 40% Extremely dense 10% Drag each response from the right column to its corresponding item in the left column. Interpreting physicians are now required by ACR to classify the breast tissue into categories. Match the type with the population percentage that falls within that category. ? Question 1 of 5 Matching Select the best answer. ? Fatty Extremely dense Question 2 of 5 When looking for cancer in the breast, which type of breast tissue would be the easiest to identify a lesion? Scattered Heterogeneously dense Multiple Choice When looking for cancer in the breast, which type of breast tissue would be the easiest to identify a lesion? Select the best answer. ? 30 60 Question 3 of 5 80% of women diagnosed with breast cancer are _____ years or older. 40 50 Multiple Choice ? Select all that apply. Question 4 of 5 Low body mass index Low body mass index Low body mass index Which of the following contribute to dense breast tissue? Age Genetics First live birth under 30 years of age Hormone replacement therapy Multiple Answer Select the best answer. ? Annually Every 3rd year Bi-annually Question 5 of 5 It is especially important for women with dense breast to ensure they get a mammogram how often? Every other year Multiple Choice It is especially important for women with dense breast to ensure they get a mammogram how often? 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Completion Question Bank 1 The Importance of Breast Tissue Density 1.1 Welcome & Objectives 1.2 Navigation Hints 1.3 What makes up breast tissue? 1.4 Breast tissue density 1.5 BI-RADS breast density categories 1.6 How does this affect cancer diagnosis 1.7 BI-RADS breast density categories 1.8 What contributes to dense tissue? 1.9 Changes in 2011 1.10 Risk assessment models 1.11 What did the study show? 1.12 Importance of risk assessment models 1.13 Supplemental screenings 1.14 How do we support our patients? 1.15 Common limitations 1.16 Keep it simple 1.17 What can your facility do? 1.18 Course Review 1.19 Disclaimer 1.20 Assessment 1.27 Completion