Initial Experience With the New York State Breast Density Inform Law at a Community‐Based Breast Center

Abstract

ammography is the only method of screening that has been shown to reduce breast cancer mortality, with a reduction of approximately 30%. 1 However, the limitations of mammography are well known and include the reduced sensitivity in dense breast tissue, which can be as low as 30% to 48%. 2,3 Detecting cancer in dense breasts has been a challenge to breast imagers; it is an important challenge to overcome, as women with dense breast tissue make up approximately half of the population in women younger than 50 years and approximately one-third in those older than 50 years. 4 Objectives-The purpose of this study was to review our initial experience with the New York State breast density inform law (New York public health law, S2404-C) at our outpatient breast center. We sought to review the findings in patients returning for screening breast sonography after a screening mammogram revealed heterogeneously dense or extremely dense breast tissue.Methods-From January 1, 2013, through May 31, 2014, 102,841 patients who underwent screening mammography were seen at our institution. Of these, 35,153 were determined to have heterogeneously dense breast tissue, and 11,864 were determined to have extremely dense breast tissue. Due to the New York State breast density inform law, these 47,017 patients were notified of their breast density, with 935 patients (2%) returning for 971 screening breast sonographic examinations.Results-Heterogeneously dense breast tissue was noted in 66% of the patients (619), and extremely dense breast tissue was noted in 34% (316). Thirty-one percent of the patients (290) reported no additional risk factors; 68% (635) presented with 1 or more additional risk factors; and 1% (10) were adopted, and the risk status could not be assessed. Twenty-five procedures (2.6%) were performed after screening breast sonography, resulting in 22 benign findings, 1 atypical finding, and 2 malignancies. The overall positive predictive value was 8% (2 of 25), and the overall cancer detection rate was 2.1 per 1000 (2 of 935).Conclusions-Handheld screening breast sonography performed in women with dense breast tissue can aid in the detection of otherwise occult breast cancer, as we found 2 cancers in the study population, with an overall positive predictive value of 8%. The addition of screening sonography in this cohort did lead to an increase in minimally invasive procedures in 2.6%.

Qualitative Versus Quantitative Mammographic Breast Density Assessment: Applications for the US and Abroad

“…A previous study in our clinic found a 2% uptake of supplemental screening ultrasound for women notified of their dense breast tissue in an initial period after implementation of the law in our state (NY) [110]. Further review of our patient population has showed a steady increase in adoption.…”

Between-race differences in the effects of breast density information and information about new imaging technology on breast-health decision-making

“…Data show that breast ultrasound identifies additional breast cancers that have been missed by mammograms among women with dense breasts [19–23], and the application of automated whole breast ultrasound imaging [24–26] makes it feasible that this modality may one day be introduced as a screening tool for women with dense breasts. Consequently, it is worthwhile to understand how making women aware of this technology will influence their decision-making.…”

New York State Breast Density Mandate: Follow‐up Data With Screening Sonography

“…We noted that the time between screening mammography and screening sonography decreased, as in this study, we found an average of 24 days, with 71% (3881) on the same day. Our prior report found an average of 65 days, with most (87%) performed on a different day . This finding was likely due to our recall protocol for these patients.…”

“…Patients are notified at the time of screening mammography of their breast density. Methods of notification at our facility, as well as standard‐of‐care procedures, have been previously reported …”