I have dense breasts. The FDA wants to make sure I know this, so I was sent a letter telling me.

The letters is the result of a new FDA requirement, and about half of women over 40 will receive a letter like I did informing them they have “dense” breasts, meaning they’re at a higher risk for breast cancer.

But what happens after they receive that letter? Absolutely nothing.

There’s no mandated follow-up testing, no requirement to offer additional imaging like ultrasounds or MRIs, and no framework to help women understand the significance of the information they’ve received. The responsibility for what to do next falls squarely on women’s shoulders.

A radiologist uses a magnifying glass to check mammograms for breast cancer in Los Angeles, May 6, 2010.  AP file photo

Dense breast tissue isn’t some minor quirk, either. The letter informs women that dense breast tissue is linked to a higher risk of breast cancer and makes detecting tumors more difficult on a standard mammogram.

This notification is just the first hurdle. For many women in Maine, especially those in rural areas, health care isn’t exactly around the corner. You can’t just pop into your local clinic for a quick ultrasound. For some, the nearest mammography center might be an hour or more away. And getting an MRI? That often means traveling even farther, navigating limited appointment slots, and juggling insurance battles just to get a scan. Even if you’re lucky enough to get an MRI appointment, who’s covering your time off from work, child care, and travel costs?

Insurance battles complicate the process even further. In a perfect world, getting a letter that says you have dense breasts would trigger immediate, follow-up care. But in America, health care is anything but straightforward. If your letter recommends further testing, you’re likely at the mercy of your insurance company. Will they cover the cost of an ultrasound or MRI? Maybe. Maybe not. And so, the cycle of phone calls, appeals, and financial strain begins.

The onus is on the patient — again, largely women — to push for answers, to advocate, to navigate a health care system that’s often opaque and indifferent to their needs. And here’s the kicker: All of this could be avoided if the system was designed to care for women proactively instead of dumping the responsibility into their laps.

The FDA’s new requirement may look like progress, but in practice, it feels more like a symbolic gesture than a meaningful step toward better health outcomes. It’s as if those responsible for this policy are checking a box: “We informed you. Our job is done.” But shouldn’t the goal be more than just informing? Shouldn’t it be about ensuring that women are able to take the next step to protect their health?

Imagine this: Instead of sending women a letter that essentially says, “Good luck,” we could be offering real solutions. Every woman who receives a dense breast notification could be immediately scheduled for a follow-up appointment. Insurance companies could be required to cover additional imaging as standard practice for women with dense breast tissue.

And in places like Maine, where access to health care can be sparse, there could be mobile clinics or state-subsidized programs to make sure no woman is left wondering what to do next.

Instead, the system puts all the burden on us. For many, the letter is a source of anxiety, not relief, as they’re left to figure out the next steps on their own. They’re expected to navigate a complex, underfunded, and often hostile health care landscape, all while working, caring for families, and trying to manage our own health. It’s another example of how women, especially those in rural areas, are being asked to do more with less.

Awareness is a good thing. But awareness without action is just noise. If we’re serious about fighting breast cancer, then giving women a piece of paper with scary news and no follow-up is woefully inadequate. It’s like telling someone their car might be about to break down and then walking away without even hinting where the nearest mechanic might be.

We need policies that offer support and ensure access to necessary care without barriers. After all, our lives — our health — deserve more than a letter. Because being told your breasts are dense is one thing; ensuring you’re protected from the risks that come with that is quite another.

As for my dense breasts? My doctor left his practice after the pandemic (like so many doctors in Maine). Years ago, he insisted on ultrasounds following my mammograms. Now that he’s gone and I don’t have any one doctor “assigned” to my care, have I fallen through the cracks? Does it matter? Do I matter? I guess I have some calls to make.

But this isn’t just my story. It’s the story of countless women navigating the same, unfair terrain.