In 2023, Allison Hamilton discovered a lump in her breast. This alarming find, along with her fibrocystic breast condition—a benign issue often resulting in lumps—prompted the need for a thorough diagnostic evaluation. Unfortunately, her insurance only covered a basic mammogram, forcing her to spend thousands on further imaging, including an ultrasound.
During this examination, the radiologist noted Hamilton’s “dense breast tissue” but didn’t elaborate, merely recommending that she should always seek additional screenings. Thankfully, the results were clear.
“It’s like, ‘No big deal,’ right?” Hamilton reflected. “I thought it was fine.”
However, in early 2025, she found another lump, distinctly painful. Once again, insurance issues prompted her to pay over $1,400 for a diagnostic mammogram and ultrasound. This led to a biopsy that, in April, confirmed she had Stage 2 triple-positive invasive lobular carcinoma.
Dense breast tissue, like Hamilton’s, is a common trait affecting approximately 40 percent of women undergoing mammograms, according to the American Cancer Society. The term “dense breasts” refers to the proportion of fat, glandular, and fibrous tissue. More glandular and fibrous tissue results in denser breasts, which occurs regardless of breast size. Each person’s density is unique.
A higher risk of developing cancer is associated with dense breast tissue; it can also obscure tumors on mammograms since both appear white. Experts have described this situation as akin to looking for a snowball in a blizzard.
“If I had only gone for the screening mammogram and not listened to my body—like, ‘Oh, this feels a bit unusual’—I might have ended up with a clean report and had to wait another year,” Hamilton, a Los Angeles mom of two, said. By that time, how much worse could things have gotten?
Many women are informed about their dense breast tissue during routine screenings or through a form letter afterwards, but there’s often little direction on what follows, especially if results are deemed “normal.” Figuring out the next steps can feel like assembling a puzzle without seeing the picture on the box.
“Patients lack guidance on additional screenings,” mentioned JoAnn Pushkin, executive director of DenseBreast-info, Inc., an advocacy group. “Nobody reaches out to say, ‘Hey, you might want an MRI.’”
Women with dense breasts might not realize that a mammogram represents just the beginning of their cancer screening journey. “It shouldn’t be the final step if catching cancer early is the aim,” Pushkin remarked.
When detected early, breast cancer has a remarkably high five-year survival rate—up to 99 percent, as noted by the American Cancer Society. However, for women with dense breasts, further examinations might be necessary to detect abnormalities.
Additional screening methods, like ultrasounds, 3D imaging, and MRIs, exist, but understanding whether one qualifies for these can be tricky, according to Wendie Berg, a radiology professor at the University of Pittsburgh School of Medicine and a chief scientific adviser for densebreast-info.org.
At present, the Food and Drug Administration mandates that breast centers notify patients about their breast density through follow-up letters. For those with dense breasts, it’s critical to know that there are different levels: heterogeneously dense and extremely dense. This distinction is vital since the risk of missing cancer on a mammogram increases with higher density levels; approximately 40 percent of cancers in extremely dense breasts are missed on these screenings. However, only the healthcare provider’s letter typically specifies a patient’s level of density.
Historically, women were often unaware of their dense breast tissue and the associated risks. Thanks to an FDA guideline enacted last year, breast centers are now obligated to inform patients of their breast density, though with minimal instructions on how to proceed beyond suggesting they consult their healthcare provider.
“How can so many women have this major risk factor and not know about it?” questioned Lauren Raineau, 40, who learned she had heterogeneously dense breast tissue only after her diagnosis of Stage 2 HER2-positive hormone-negative breast cancer in 2024. A screening mammogram remains essential in identifying breast cancer, but it’s crucial to discuss whether it’s sufficient with a healthcare provider, emphasized Pushkin.
If your breast density is extremely dense, additional screenings are advisable, Berg recommended. For those with heterogeneously dense tissue and other risk factors, further evaluation is warranted. Of course, these additional tests can lead to more, resulting in stress and added expenses.
For women needing supplemental breast screenings, MRI has shown to be a more effective cancer-detection method, based on a clinical trial study. “Ultimately, if you qualify for an MRI, it’s in your best interest to get one,” Berg asserted.
The challenge then becomes accessibility. At the University of Pittsburgh Medical Center, for instance, patients face a six-month wait to schedule a screening MRI. Moreover, many insurance plans—like Hamilton’s—still do not cover supplementary screenings, leaving individuals to foot the hefty bill for preventive tests, often year after year.
Thirty-six states and the District of Columbia require insurers to cover secondary screenings, but federal plans such as Medicare and Medicaid are not bound to these regulations. The situation persists with big national insurers, including UnitedHealthcare and Aetna. Legislative efforts to address the insurance gap have repeatedly failed. The Find It Early Act aims to mandate that all insurers, including Medicare and federal entities, cover diagnostic breast imaging without copays, and the Access to Breast Cancer Diagnosis Act has been introduced but excludes federal plans. Both pieces of legislation are anticipated to be reintroduced. Meanwhile, how many more women with dense breasts will experience delays in their cancer diagnoses while lawmakers continue to discuss these matters?
After my initial mammogram, I received a form letter informing me of my dense breast tissue status. Since my routine screening didn’t indicate any issues, I didn’t give it much thought. Then, during a casual gathering with women, the topic of breast density emerged. Surprisingly, every woman there shared that she, too, had dense breasts, joking that perhaps self-massage could help. We all laughed, starting to massage our own breasts.
In the process of gathering information for this article, I learned that self-massage isn’t effective. It’s unfortunate, but until we bridge the information and insurance gaps, this remains our reality.
