The California Breast Density Information Group: A Collaborative Response to the Issues of Breast Density, Breast Cancer Risk, and Breast Density Notification Legislation

Abstract

In anticipation of breast density notification legislation in the state of California, which would require notification of women with heterogeneously and extremely dense breast tissue, a working group of breast imagers and breast cancer risk specialists was formed to provide a common response framework. The California Breast Density Information Group identified key elements and implications of the law, researching scientific evidence needed to develop a robust response. In particular, issues of risk associated with dense breast tissue, masking of cancers by dense tissue on mammograms, and the efficacy, benefits, and harms of supplementary screening tests were studied and consensus reached. National guidelines and peer-reviewed published literature were used to recommend that women with dense breast tissue at screening mammography follow supplemental screening guidelines based on breast cancer risk assessment. The goal of developing educational materials for referring clinicians and patients was reached with the construction of an easily accessible Web site that contains information about breast density, breast cancer risk assessment, and supplementary imaging. This multi-institutional, multidisciplinary approach may be useful for organizations to frame responses as similar legislation is passed across the United States. Online supplemental material is available for this article.

Impact of the California Breast Density Law on Primary Care Physicians

“…Only 30% of clinicians were completely or mostly comfortable answering breast density related questions and the vast majority of respondents felt they would benefit from educational sessions about breast density. However, primary clinicians did express strong interest in further education, which potentially could be provided to small group sessions by breast imagers, or by online resources such as those developed by the California Breast Density Information Group (CBDIG) [5]. …”

“…Risk assessment aids primary clinicians in deciding which of the many women with dense breasts would benefit from supplemental screening, which is ultimately the goal of the legislation [5]. However, the majority (74%) of primary clinicians did not report performing quantitative risk assessments on their own, rather deferring them to a breast health specialist.…”

“…Roughly 50% of women in national studies have breast tissue that is classified as mammographically “dense”; thus approximately 2 million women in the state of California receive this notification annually. [5–7]…”

Mammographic Breast Density as a Risk Factor for Breast Cancer: Awareness in a Recently Screened Clinical Sample

“…For instance, in California, more than 2 million women each year will receive a notification letter that they fall into the heterogeneously or extremely dense categories (Price et al, 2013). As noted by the California Breast Density Information Group (Price et al, 2013), risk assessment for this population as a whole would place an inordinate demand on providers.…”

“…For instance, in California, more than 2 million women each year will receive a notification letter that they fall into the heterogeneously or extremely dense categories (Price et al, 2013). As noted by the California Breast Density Information Group (Price et al, 2013), risk assessment for this population as a whole would place an inordinate demand on providers. Clinical systems that trigger the presence of additional risk factors, such as a positive family history or history of atypia at a previous biopsy, would allow for the limited resource of clinician time to be focused on risk counseling for women most at risk.…”