Abstract P6-10-11: State based dense breast legislation and its effect on patient awareness

Abstract

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.