Call to Health Minister: ‘Give MRI to women with dense breast tissue’

The uproar arose after an article in of Volkskrant and subsequent coverage by Eva Jinek. In Ineke van den Heuvel, a suspicious area was missed during population screening because her breast tissue was too thick. As a result, the cancer was only discovered later.

Ineke didn’t know she had thick breast tissue. When asked why she was never told this, the radiologist said they were not authorized to provide that information.

‘Instant message went viral’

That was wrong not only for Ineke, but also for Amy-Jane Gielen, who noticed a message about this LinkedIn posted. “Sometimes I go viral with a message, but this has been shared a lot,” she says. “Many women accepted with disbelief, but women also shared personal and vulnerable stories. Some of them were diagnosed with breast cancer late. And they only found out later that tissue breast thickness on them and therefore the tumor was lost.”

She discovered what women can do themselves. “If you’ve had mammography in a hospital, you can see in your personal patient file what breast density you have, which the radiologist notes.” Breast density is not recorded in general population screening for breast cancer, although it is easy to measure. “Also ask specifically about your breast density during this examination. The more women do this, the more likely they are to measure it.”

Hard to find

The problem in short: there is a certain concentration of glandular or fatty tissue at the breast, breast density. It is divided into four sections. Types a and b have a lot of fat. The chest is darker on X-ray. Types c and d have a lot of glandular tissue. Scan shows a lot of white there. A suspicious area that may indicate breast cancer is also white and therefore much more difficult to detect, especially in type D.

Of the women called for population screening, around 80,000 have very dense breast tissue. Not only are they twice as likely to develop breast cancer as the average woman, 4 out of 10 tumors are also not visible on population screening X-rays. A ten-year scientific study among Dutch women showed that these tumors are visible on MRI. Eleven lives in a thousand women can be saved if women with type D have an MRI.

Health Council

Research from Erasmus University shows that additional MRI screening is cost-effective. They compared the costs of women who are sick with the costs of women who get a preventive MRI. However, the Ministry of Health decided not to do anything with this research because the Health Council advised that MRI might not be protective in the future. Although there are plenty of MRIs available, a large national study by KMPG also showed, this would not be possible due to a lack of staff. The Health Council also reported that false positive results, if you are told after a biopsy that it is not cancer after all, ‘would put too much psychological and physical stress on women’.

‘Nothing changes’

The Dutch Breast Cancer Society would like to see further development of the breast cancer population survey. That’s why she is one a petition launched in which she asks women to tell them if they have thick breast tissue. “The scientific research on this is five years old. We have been trying to draw attention to this topic for years through discussions and letters to ministers and secretaries of state,” says Marjolein Scholten from the Cancer Society. Holland’s chest. But so far nothing seems to have changed.”

“If radiologists indicate that it is important, if research shows that it is cost-effective, if all the signs are green, why is this not implemented? We do not want to to do too much healthcare, but we recommend an action-oriented approach. For example, you could use AI Being able to read X-rays is already done in Scandinavian countries.

Easy to measure

There is a reason why the button in the mammogram bus is not turned on, radiologist Wouter Veldhuis from UMC Utrecht knows. He researched the impact of additional screening. “Breast density is actually easy to measure, but the problem is that you can’t track it at the moment. Women can be told they have dense breast tissue, but then they can’t do anything with that information.”

He also wants women with type D breast density to be screened as soon as possible. “There are enough MRI scanners. If we extended the scanning hours, so evenings and weekends, we could easily do 20,000 scans a year. The problem is in workers.the scans?healthcare is stressed, but strict means to make choices.

‘I can’t do anything’

But Veldhuis is also critical of sharing information with women. “Imagine you know you have a higher risk, so you can’t do anything. Also, we have to keep remembering that most people don’t get cancer. There are many factors there are others who are also involved in a greater risk, such as at what age did you get cancer further suggesting that.

According to Veldhuis, as soon as the Ministry of Health, Welfare and Sports decides that women with thick breast tissue will receive additional screening, the switch will immediately turn on the mammogram bus. “I hope the minister will come to this decision soon.”

The Secretary of State will speak