Women with dense breasts are known to be at higher risk for breast cancer and are more likely to have a malignancy missed during a mammogram. And if women think they have dense breasts and are told what that means, they appear to be willing to pay a few hundred dollars out-of-pocket for ultrasound or contrast-enhanced mammography scans that could help better detect cancer, according to a small, new survey presented this week at RSNA 2012.

The study also found that nearly three-quarters of women surveyed had no idea what their breast density was.

"The majority of women were interested in supplemental screening technologies and this interest remains despite the potential of out-of-pocket costs and the risk of false positive results," Haatal Dave, a radiology resident a Yale University and author of the study, told reporters during a press conference in Chicago.

The eight-question survey was answered by 105 out of 130 women undergoing routine screening mammography over a nine-day period at an outpatient center of Stanford University, where Dave had previously worked. Over half were aged 50 and above.

In addition to the questions, the survey described breast density. It also described how automated whole breast ultrasound and contrast-enhanced spectral mammography might increase the sensitivity of breast exams at the cost of increasing the rate of false positives.

While 42 percent of the surveyed population had dense breasts (44 out of 105), 76 percent weren't aware of their breast density or its effect on cancer risk. "Older (patients) were not more aware, and women with dense breasts were not more aware of their breast density than women with, say, fatty breast tissue," Dave said.

But when asked to imagine if they had dense breasts, a majority of respondents said they were willing to pay out-of-pocket for two $300 to $500 supplemental tests, ultrasound and contrast-enhanced mammography.

For women in their 40s who took the survey, 63 percent were willing to pay for ultrasound or CE mammo, while for women 50-74, 72 percent would pay for ultrasound and 65 percent for the contrast mammo, Dave said.

After being informed that the supplemental scans could increase the risk of getting a biopsy, even though the women did not have cancer, majorities still wanted to have the scans. For younger women, 73 percent were still interested in ultrasound and spectral mammography, while 68 percent of older women were still in the two exam types.

Dave acknowledged limitations with the study, however. It was carried out at a single academic medical center, so it's not generalizable to a wider population, she said. Dave said they were planning on expanding the study to other populations, including non-English speakers.

Concerns over breast density have led at least five states to pass laws mandating that radiologists inform patients of their density in their annual mammography reports. But not all states set aside money to finance suggested supplemental tests, such as ultrasound or MRI, and this could create access problems, according to Dr. Jafi Lipson, an assistant professor of radiology at Stanford and a co-author of the study.

She said if these results hold true for low-income women — that they are interested in supplemental screening — then the lack of financing could "create a potential environment of a two-tiered system."

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