Dense Breast Legislation in the United States: State of the States

Dehkordy, Soudabeh Fazeli; Carlos, Ruth C.

doi:10.1016/j.jacr.2013.09.007

Cited by 50 publications

(45 citation statements)

References 8 publications

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“…To ensure that women with dense breasts are aware of the limitations of mammography and their increased breast cancer risk, about half of US states currently have passed legislation mandating the disclosure of breast density directly to women (3). In many states these notifications are required to include language advising the woman to discuss supplemental screening tests with her providers if her breasts are considered to be dense (4, 5). National legislation is currently under consideration (6) and the Food and Drug Administration is also considering an amendment to its regulations issued under the Mammography Quality Standards Act that would require density reporting to patients (7).…”

Section: Introductionmentioning

confidence: 99%

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice

et al. 2016

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Background About half of US states currently require radiology facilities to disclose mammographic breast density to women, often with language recommending discussion of supplemental screening options for women with dense breasts. Objective To examine variation in breast density assessment across radiologists in clinical practice. Design Cross-sectional and longitudinal analyses of prospectively collected observational data. Setting Thirty radiology facilities within the three breast cancer screening research centers of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Participants Radiologists who interpreted ≥500 screening mammograms during 2011–2013 (N=83). Data on 216,783 screening mammograms from 145,123 woman aged 40–89 years were included. Measurements Mammographic breast density as clinically recorded using the four Breast Imaging-Reporting and Data System density categories (heterogeneously dense and extremely dense categories were considered “dense” for analyses); patient age, race, and body mass index (BMI). Results Overall, 36.9% of mammograms were rated as dense. Across radiologists, this percentage ranged from 6.3% to 84.5% (median 38.7%, interquartile range 22.0%), with multivariable adjustment for patient characteristics having little impact (interquartile range 20.9%). Examination of patient subgroups revealed that variation in density assessment across radiologists was pervasive in all but the most extreme patient age and BMI combinations. Among women undergoing consecutive exams interpreted by different radiologists, 17.2% (5,909/34,271) had discordant assessments of dense/non-dense status. Limitations Quantitative measures of mammographic breast density were not available for comparison. Conclusions There is wide variation in density assessment across radiologists that should be carefully considered by providers and policy makers when considering supplemental screening strategies. The likelihood of a woman being told she has dense breasts varies substantially according to which radiologist interprets her mammogram. Funding Source National Institutes of Health

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Section: Introductionmentioning

confidence: 99%

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice

et al. 2016

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“…Consequently, the false-negative rate of screening mammography varies as much as 10-fold from the lowest to the highest categories of breast density(5). Because breast density affects cancer risk and the false-negative rate of screening, at least nineteen states have enacted legislation requiring that women with dense breasts be told of their breast density following a screening mammogram and that they might benefit from supplemental screening tests such as ultrasound(7, 8). Similar legislation is under consideration at the national level(9).…”

Section: Introductionmentioning

confidence: 99%

Benefits, Harms, and Cost-Effectiveness of Supplemental Ultrasonography Screening for Women With Dense Breasts

et al. 2015

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Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing screening mammography would substantially increase costs while producing relatively small benefits in breast cancer deaths averted and QALYs gained. Primary Funding Source National Institutes of Health

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“…Many additional states are currently in the process of passing similar legislation, and federal legislation regarding breast density notification is currently under review by a congressional committee. [1,2]…”

Section: Introductionmentioning

confidence: 99%

Impact of the California Breast Density Law on Primary Care Physicians

Khong

Hargreaves

Aminololama-Shakeri

et al. 2015

Journal of the American College of Radiology

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Purpose To investigate primary physician awareness of the California Breast Density Notification Law and its impact on primary care practice. Materials and Methods An online survey was distributed to 174 physicians within a single primary care network system 10 months after California’s breast density notification law took effect. The survey assessed physicians’ awareness of the law, perceived changes in patient levels of concern about breast density, and physician comfort levels in breast density management issues. Results The survey was completed by 77 physicians (45%). Roughly half of those surveyed (49%) reported no knowledge of the breast density notification legislation. Only 32% of respondents noted an increase in patient levels of concern about breast density compared to prior years. The majority were only “somewhat comfortable” (52%) or “not comfortable” (10%) with breast density questions, and almost one-third (32%) had referred patients to a breast health clinic for these discussions. 75% of those surveyed would be interested in more specific education on the subject. Conclusion Awareness of California’s Breast Density Notification Law among primary care clinicians is low, and many do not feel comfortable answering breast density related patient questions. Breast imagers and institutions may need to devote additional time and resources to primary physician education in order for density notification laws to have significant impact on patient care.

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Dense Breast Legislation in the United States: State of the States

Cited by 50 publications

References 8 publications

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice

Benefits, Harms, and Cost-Effectiveness of Supplemental Ultrasonography Screening for Women With Dense Breasts

Impact of the California Breast Density Law on Primary Care Physicians

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