The Future Of Early Breast Cancer Detection For Women With Dense Breast Tissue by Lisa Malia Norman, MSM, CEO
"You Are the CEO of Your Own Health": What We Learned About the Future of Early Detection for Women with Dense Breast Tissue
By Lisa Malia Norman, Founder & CEO, For The Love Of Cups ·
Highlights from our webinar with a Stanford breast radiologist, a breast surgical oncologist and the president of the Black Women's Health Imperative on early detection for dense breast tissue, risk, screening options and access.
This conversation has been on my heart since 2014, when I was told I had dense breast tissue and felt blindsided. I was a midwife. My mother was a two-time breast cancer survivor. I thought I knew things. I didn't know what to do next, so I did what many of us do: I went down a rabbit hole and got very good at asking questions.
More than a decade later, women are now notified about their density, but many still don't know what happens next. On November 10, I hosted a free webinar with three people I admire to talk about it honestly. If you missed it, here's what stayed with me. [Watch the recording]
Our panel
Dr. Brittany Dashevsky, breast imaging radiologist, Clinical Associate Professor of Radiology at Stanford Medicine, and breast cancer researcher
Dr. Monique Gary, DO, MSc, FACS, FSSO, SVP, CMO Bexa, Inc. breast surgical oncologist at St. Luke's University Health Network and chief medical officer at Bexa, an early detection company
Joy D. Calloway, president and CEO of the Black Women's Health Imperative
The webinar was co-sponsored by MedTech Women, Women's Health Advocates, Wilson Sonsini Goodrich & Rosati, the Black Women's Health Imperative and Bexa, Inc. Thank you also to Brian Hargreaves at Stanford for the introduction to Dr. Dashevsky.
Density is something you see on a mammogram, not something you feel
Dr. Dashevsky opened with images from a real mammogram. Fatty tissue looks dark. Glandular tissue looks white. Dense tissue and cancer both look white, which is why density can make cancer harder to find.
She explained that density is sorted into four categories, A through D. About 10% of women fall in A (mostly fatty) and about 10% in D (extremely dense), with roughly 40% each in B and C. When we say a woman has dense breasts, we mean categories C and D.
And it's not the same as how your breasts feel. Dr. Gary shared that a survey found many women believe they can feel density by touch. "Just because a breast feels soft doesn't mean it isn't dense," she said, "and just because a breast feels firm doesn't mean it is." Today, density is an imaging assessment.
Your density can change, and that is normal
Density is read by a radiologist, so it's partly subjective. Two radiologists can read the same mammogram differently, especially if you're on the line between B and C. It can also change over time with menopause, pregnancy, hormone therapy and weight changes.
This mattered to Joy, who was told she had dense breast tissue and years later was told she didn't. "No one had ever said that to me," she told us. "Had I known that, I would have reacted much differently at that front desk that day." A short explanation could have preserved her trust.
Density is one part of risk, not the whole picture
Dense tissue is an independent risk factor, because it contains hormone-sensitive glandular tissue. Dr. Dashevsky noted that the increase in risk between the lowest and highest categories is meaningful, while the difference between B and C is much smaller. She stressed that density is one factor among many and that density and risk are different questions.
Her advice: check your mammogram letter for your density, and complete a risk assessment, such as the free Tyrer-Cuzick model she shared. Dr. Gary added that the conversation about risk should begin at age 25, in line with guidance from several professional organizations. She also reminded us not to assume that having no family history means no risk, because many women diagnosed when they're younger have none of the common risk factors.
There are options, but access is uneven
Dr. Dashevsky walked through what's available:
Tomosynthesis (3D mammography), which she said everyone should receive, whether dense or not.
Screening ultrasound, which has no radiation and finds additional small cancers, with more false alarms.
MRI, the most sensitive test, but also the most expensive. It's typically recommended in addition to mammography for women with 20% or greater lifetime risk.
Abbreviated MRI, a shorter, more affordable version that is a supplemental option for dense breasts but isn't offered at most places and is often paid out of pocket.
Contrast-enhanced mammography, whose sensitivity approaches MRI. It's used for women at increased risk who can't have an MRI, and is also offered off-label for women with dense tissue.
The honest challenge, as she put it: "Those with resources are able to get it and others are not." The best test for you depends on your risk, your density and your history, so talk with your doctor.
What's coming, and who it has to include
Panelists were excited about what's on the horizon: shorter and more comfortable MRI protocols, AI that can help assess density and risk, and blood-based tests, which Dr. Dashevsky said haven't done well for breast cancer yet but are a matter of time. Dr. Gary described approaches that don't depend on breast density as a way to support women who delay or can't access standard imaging. (Dr. Gary is a chief medical officer of Bexa, one of the webinar's co-sponsors.) She was clear that mammography remains the standard.
Joy's challenge to innovators stayed with me: include Black women in the conversation early. "Trust is built before you need it," she said, in her own words, "you build the relationship and nurture it before the new technology arrives." Dr. Dashevsky agreed that AI is only as good as the data it learns from, so the more women from different groups are included, the better these tools work.
Two experts in the room
Joy offered the line I keep repeating: when you walk into an appointment, there are two experts in the room. Your clinician knows medicine. You know your body, your history and how your breasts have changed. "You are the CEO of your own health," she and Dr. Gary both said.
That starts with questions. Dr. Dashevsky's tip: if you have a question, tell the technologist you'd like to speak with the doctor. Joy added that physician assistants, nurse practitioners and community health workers can give extra time. The first resource I ever created was four questions to ask at your mammogram appointment, and women still tell me they didn't know they could ask.
What you can do
Find your density on your mammogram report, and ask your doctor, "What does this mean for me?"
Complete a risk assessment and revisit it as your history changes Risk Assessment Calculator
Ask which screening options are right for you, and what your insurance covers.
Keep up with screening, and report any change you notice in your breasts.
Advocate. Visit Women's Health Advocates to contact our representatives about coverage for supplemental screening and diagnostic workups, so cost doesn't decide who is screened
Tell us your story. If you've been told you have dense breast tissue, take our survey.
Help us close the gap
The Healthy Breast Report is a national patient survey from For The Love Of Cups about what happens after a dense breast notification: what women understood, what they were offered, and whether the next step happened. It's open through March 31, 2027, and the research has an exemption determination from Sterling IRB.
Take the survey: [LINK]
Become a Community Partner and share it with women you serve: [https://luma.com/a8xy4m0h]
Join us at The Breast Density Summit, March 4, 2027, in Palo Alto: [LINK]
This was the first conversation in a series. Subscribe to hear about the next one.
This post is for education and is not medical advice. Please talk with your own clinician about your screening and care. Opinions expressed are those of the individual speakers.
Every woman deserves to know, as early and as clearly as possible, what's actually happening in her body. Not what the density of her tissue allows a mammogram to see. Not what fits neatly into a standard protocol. The truth — the whole truth — about both breasts, healthy or not.
That's what we're building toward. That's why it's called The Healthy Breast Report – we’re building it now and revealing it, this October at The Breast Density Summit. You can help by bringing it directly to your community, screening center or organization today.
The Breast Density Summit brings together patients, physicians, researchers, and industry leaders for a day dedicated to elevating the conversations, innovations, access and delivery of care when screening breast density — its role in cancer risk, the limits of standard mammography, and what patients need to know to advocate for themselves. The summit combines expert panels, patient stories, and actionable next steps for attendees and the broader healthcare community.
This inaugural summit will host the Bay Area launch of the Clear Pathways Program, an initiative dedicated to closing the gap women with dense breast tissue face in receiving timely, appropriate follow-up care. Clear Pathways works to standardize the journey from a breast density finding through supplemental screening and diagnosis — removing the confusion and delay that too often follow an unclear mammogram result. Launching the program in the Bay Area, a region defined by its density of biotech, healthcare, and research institutions, is a pivotal next step for the initiative.
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