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Recent efforts by advocacy groups to enact state government mandated legislation requiring that patients with dense breast tissue be informed of their breast density has been met with mixed responses by the medical community and cancer advocacy groups. Breast density has been well characterized as a risk factor for breast cancer, and is known to make mammogram interpretation more difficult. There are no formal recommendations for additional screening and management of patients who have dense breasts. There is no standard measurement in place for what defines dense breasts on mammography. Many women's health practitioners seeing radiology reports that comment on breast density are not adequately prepared to counsel patients in terms of best practice, as guidelines do not exist. Despite uncertainty of how knowledge of breast density impacts ongoing imaging or whether it impacts cancer early detection, 21 states have now enacted laws mandating breast density reporting It is unclear whether in states with mandatory reporting more patients are actually being informed about their breast density. "Are You Dense", the advocacy group driving this legislation, states that 40% of women have dense breast tissue and that 95% of these women are unaware of their breast density. The aim of this patient survey study was to determine whether state legislation for mandatory breast density reporting has altered the number of women informed about their breast density compared to states without mandatory reporting. A 19 question survey was introduced using the social media site Facebook targeting women who are health conscious. Patients were asked to answer questions about their age, personal and family history of cancer, personal and family history of genetic testing, health behaviors including tobacco and alcohol intake and exercise habits and BMI, and personal history of breast screening results and whether they had been told they had dense breasts by a health care provider. Results were recorded and data analyzed using chi square and student t test. 17,936 women visited the survey site, and 15,392 women completed the survey. Of these, 3,536 women reported to be over 40 and eligible for mammography screening. 1,997 (56%) reported that they had been informed by a health provider that they had "dense breast tissue". Among patients residing in the 21 states with mandatory reporting, 59% (1231 out of 2098 responding) reported being told they had dense breasts vs 53% (766 out of 1438) of patients residing in states without mandatory reporting. While groups advocating for mandatory reporting of breast density want to ensure that women with dense breast tissue are informed of their risk, and have access to an early breast cancer diagnosis, it is yet unclear whether this legislation impacts early cancer diagnosis or whether patients are actually being informed with increased frequency based on the legislation. Our study did not show a significant difference in the number of patients being informed of increased breast density in states with mandatory reporting. Additional studies are required to determine whether this legislation has any impact on patient awareness, uptake of additional screening, and earlier detection of breast cancer. Citation Format: Lindner D, Vasic J. State based dense breast legislation and its effect on patient awareness. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-11.

Introduction: Awareness about genetic predisposition to breast and ovarian cancer and access to genetic testing has increased dramatically over the last decade, particularly with the increase in direct to consumer marketing of genetic testing. While professional organizations have published bulletins addressing this topic, a working knowledge of how to identify and manage high risk patients is lacking among many physicians. The goal of this pilot study was to assess knowledge deficits in breast and ovarian cancer risk assessment and management among primary care residents and to determine whether a novel approach to teaching this subject will help bridge the perceived knowledge gap. Methods: A novel case based learning module was developed by a multidisciplinary team of Breast Surgeons, Gynecologic Oncologists, Obstetrician/Gynecologists, Psychologists and Genetic Counselors as a practical approach to assessing risk level based on personal and family history and applying standard recommendations for screening and risk reduction. This approach is unique, as lectures in an academic setting often focus on management of high risk patients, but not on risk stratification and risk reduction in all comers. Surveys were completed by residents after the workshop to assess perceived knowledge before and after the presentation. Results: 106 residents from Internal Medicine, Obstetrics and Gynecology and Family Medicine residency programs were surveyed after participating in the lecture and case based learning module. 87 (82%) responded that the information presented was new to them. 101 (95%) responded that the training increased their knowledge about the options available to young women for risk reduction and early detection of breast and ovarian cancer. 105 (99%) responded that after attending the training, they understood how to identify patients that are at an increased risk for developing breast and ovarian cancer and should be referred for genetic counseling and testing. 100 (94%) indicated they would incorporate material in the training into their everyday practice. Discussion: Resident surveys confirmed there is a knowledge gap among trainees in breast and ovarian cancer risk assessment and management. While professional organizations have created guidelines for patient management, most trainees are either unaware of recommendations, or feel the information is not being presented in a way that allows them to use it practically in patient management. The novel educational workshop presented here increased perceived knowledge among residents, allowed them to correctly identify high risk patients, and increased their working knowledge of risk reduction strategies among high and low risk patients. Recent studies have demonstrated poor coordination of care and lack of followup for the majority of high risk patients who do not opt for risk reducing surgery within the first few months after diagnosis of a gene mutation. The need for more comprehensive education among emerging medical professionals in this area is clear. Using a practical, risk stratification approach to identify and manage high risk patients is successful in bridging the knowledge gap among residents in primary care specialties. Citation Format: Deborah S Lindner. Managing breast and ovarian cancer risk: A novel approach to teaching residents comprehensive risk reduction and management strategies [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-11-02.