Standard Mammogram Screenings May Not Be Enough

Mammograms have saved countless lives by catching breast cancers early, but they are not perfect and often leave gaps that put women at risk. For many women, especially those with dense breast tissue or additional risk factors, a clear scan does not always mean safety.

According to the American Cancer Society, mammograms miss about one in eight breast cancers. The issue becomes more complicated for women with dense breast tissue where detection rates can drop significantly. Dense tissue and tumors both appear white on a mammogram which makes cancer harder to spot. Nearly half of all women have dense breasts, yet many are never told how this impacts their screening results or their next steps.

False negatives are not the only concern. False positives are also common, especially for younger women, those with dense breasts, or those who have had previous biopsies or hormonal exposure. Over a ten-year period, about half of women who undergo annual mammograms will receive at least one false-positive result. These calls for additional imaging or biopsies can create unnecessary anxiety and lead to delays in follow-up care.

According to the U.S. Preventive Services Task Force, there is still not enough evidence to recommend additional screening like ultrasound or MRI for women with dense breasts when their mammograms appear normal. This leaves thousands of women in a gray area, unsure of what to do next, and insurance coverage for supplemental screenings varies widely across states.

New technology offers hope. Supplemental imaging such as breast ultrasound and MRI can reveal cancers that mammograms miss, particularly in dense tissue. Contrast-enhanced mammography, an emerging tool, has shown the ability to detect up to four times as many invasive cancers as ultrasound and can match the detection rates of MRI while being more affordable and accessible.

Advocates like the late Nancy Cappello helped drive the push for better patient awareness. After her mammogram failed to catch her tumor, she discovered she had extremely dense breast tissue that masked it. Her experience led to new laws in 37 states requiring women to be notified about their breast density and informed of the limitations of mammography. Yet awareness remains low, and access to follow-up screenings is still uneven.

A mammogram is an important tool, but for many women, it is only the beginning. To save more lives, we need universal breast density notification laws, standardized access to supplemental imaging, better insurance coverage, and clear education campaigns that help women understand their risk and options.

Real progress begins when women are fully informed, doctors have the right tools, and policymakers prioritize access to care. Until then, too many cancers will remain hidden, and too many women will fall through the cracks.