• Mandatory Reporting Of Breast Density In Screening Mammograms. Why The Controversy

    Elaine Schattner

    imagesRecently, the Governor of Michigan signed into law a requirement that radiologists inform women if their mammogram reveals dense breasts. The law will take effect on June 1, 2015. With this act, Michigan became the 21st state to enact legislation on mandatory reporting of breast density found in breast cancer screening.

    The surprisingly controversial law, having to do with a woman’s right to know if her mammogram result is unclear, may go national: Last July, Senators Dianne Feinstein (D-Calif.) and Kelly Ayotte (R-N.H.) introduced the Breast Density and Mammography Reporting Act. Similar legislation repeatedly has been put before Congress by Rep. Rosa DeLauro (D-CT) and co-sponsors. [Read More…]

  • Breast density: over 700,000 UK women living with ‘hidden’ breast cancer risk

    1 October 2014

    Risk Determination and Prevention of Breast Cancer[1], published in the journal Breast Cancer Research, identifies the critical gaps that must be addressed if we are to reverse the increase in breast cancer expected over the next 10 years – and reach a tipping point where more breast cancers will be prevented in the general population, not only in women at high risk. High breast density is highlighted as a significant risk factor for breast cancer that could play a key role in redefining the risk of breast cancer faced by each individual woman.

    WH_stages_of_breast_cancer-300x193The number of people diagnosed with breast cancer in the UK is on the rise and this trend is projected to continue until at least 2030. The increase is partly due to an aging population, insufficient levels of physical activity, increases in obesity and alcohol consumption, women having fewer children and having them later in life, all of which are risk factors for the disease.

    The 4 key risk and prevention gaps identified in Risk Determination and Prevention of Breast Cancer are:
    Risk estimation: Accurate ways to estimate risk in the general population and in women at high risk. Adding information about breast density and newly identified genes is likely to improve existing models. [Read More…]

  • Breast Density Inform Inconsistency Delivers Confusion

    July 17, 2014
    This first appeared in the July 2014 issue of DOTmed HealthCare Business News

    breast_density_pie_chart_exampleWe have reached the tipping point. We have reached the tipping point. By population, over fifty percent of American women now live in states that require breast density information be provided to them in the letter they receive after their mammogram. Nineteen states have now enacted some variation of mandatory inform. But the notification women receive varies state to state, with the level of detail differing and not necessarily consistent with the information to be discussed with their physicians.

    Individual state reporting standards have resulted in inconsistent notification. The specificity and depth of density information a woman receives will depend on what is required in her home state. For instance, in some states women receive only general information about breast density, while in other states, women receive clear and unambiguous notification that they have dense breasts. [Read More…]

  • Minnesota and Rhode Island enact breast density laws

    May 27, 2014

    dense-breastsby Loren Bonner , DOTmed News Online Editor

    This week, Gov. Lincoln Chafee signed Rhode Island’s breast density inform bill into law, and late last week, Gov. Mark Dayton did the same for Minnesota women.

    Breast density laws require physicians to inform women if they have dense breasts along with the possible risks that can be present.

    Minnesota becomes the sixteenth state with mandatory breast density notification for women, and Rhode Island became the seventeenth.

    Connecticut was the first state to pass breast density inform legislation in 2009, followed by Texas, Virginia, California, New York, Hawaii, Maryland, Alabama, Tennessee, Nevada, Oregon, North Carolina and Pennsylvania, New Jersey, Arizona and now Minnesota and Rhode Island. [Read More…]

  • Gov. Jan Brewer signs Breast Density Law

    April 22, 2014

    by Loren Bonner , DOTmed News Online Editor

    breastdensitylawArizona became the fifteenth state to require physicians to inform women if they have dense breasts along with the possible risks that can be present.

    After legislation was introduced at the request of a diagnostic radiologist in Arizona, and went through the procedural votes in both chambers, Governor Jan Brewer signed SB 1225 into law late last week.
    According to JoAnn Pushkin, founder of D.E.N.S.E. NY, 50 percent of U.S. women now live in states where density notification is required.

    Connecticut was the first state to pass breast density inform legislation in 2009, followed by Texas, Virginia, California, New York, and most recently Hawaii, Maryland, Alabama, Tennessee, Nevada, Oregon, North Carolina and Pennsylvania, New Jersey and now Arizona. [Read More…]

  • National Breast Density Notification Amendment Advances

    August 13, 2013

    by Nancy Ryerson , Staff Writer

    The fight for breast density notification legislation has taken another step forward. Advocates proposed an amendment to the Mammography Quality Standards Act (MQSA) that would require that women screened for breast cancer be informed if they have dense breasts.

    Currently, 12 states have enacted breast density inform laws. But language in the inform letters vary among the states, and women who live in states without the laws are often left in the dark about their status. Breast density makes cancer very difficult to spot on a mammogram and raises a woman’s risk of developing breast cancer.

    “For example if you live in New York, you’ll get your results, but if you’re in New Jersey you won’t because their law hasn’t passed yet,” JoAnn Pushkin, who proposed the amendment, told DOTmed News. She’s the co-founder of Density Education National Survivors’ Effort. “And it can really be a question of life or death.”

    Pushkin approached the FDA about adding an amendment and learned, fortuitously, that the MQSA was up for reauthorization. Together with other advocates and radiologists, Pushkin succeeded in getting the agency to consider the regulatory amendment.

    She hopes the amendment will require notification in states that clearly and unambiguously tell a woman she has dense breasts, and for doctors to explain what that means. Less effective language, such as that sent out in Maryland, starts notification with “If your mammogram shows that your breast tissue is dense you should know…”, a potentially confusing message.

    “I’m hoping that it would be at least as stringent as the best state language, like the kind used in New York,” said Pushkin.

    Though recent studies have called ultrasound the best imaging method for dense breasts, Pushkin doesn’t think the notifications should include any further prescriptive advice beyond encouraging women to discuss further steps with their doctors.

    In December, the proposal will be submitted for public comment. Pushkin hopes to see the amendment incorporated some time in 2014.

  • Dense breasts may need more screening

    United Press International

    Women with dense or non-fatty breast tissue may need additional breast cancer screening, a U.S. researcher says.

    Dr. Roshni Rao, assistant professor of surgery at the University of Texas Southwestern Medical Center in Dallas, said one woman’s personal battle with breast cancer was the inspiration for Henda’s Law — a Texas law named for Henda Salmeron that requires women to be informed about their breast tissue’s density and the limitations of mammography in certain cases.

    Rao, Salmeron’s breast surgeon, said radiologists use a grading system to describe the density of breast tissue based on the amount of fat (non-dense) and connective (dense) tissue. Research is under way into why some women have denser breast tissue, but as women age, their breast tissue generally becomes more fatty, Rao said.

    “Breast tissue that has minimal or no fat may appear white, or dense, on a mammogram. This sometimes makes it difficult to identify cancers, which also typically appear as small white spots,” Rao said in a statement. “Many factors contribute to a woman’s risk of breast cancer. Having dense breast tissue may be one of them, but your doctor considers other factors — age at which a women had her first child, family history of cancer or age at the onset of menstruation, among others — when evaluating your risk and tailoring your screening program.”

    Digital mammograms may be best at finding cancer for women with dense breast tissue. Other tests, including breast magnetic resonance imaging and ultrasound and breast thermography, may be helpful, but only in addition to mammograms, Rao said.

    Copyright United Press International 2011

  • California Passes Breast Density Bill

    September 16, 2011
    by Brendon Nafziger, DOTmed News Associate Editor

    The California State Legislature passed a bill last Friday requiring doctors to inform women if they have dense breasts after a mammogram, making California the second state this summer and the third state so far to have passed a so-called breast density law.

    The bill, SB 791, passed the state Senate 35-1, and is now going before Gov. Jerry Brown to get signed.

    When he signs it, starting next year, Calif. radiologists will have to send women with dense breasts, as determined by an American College of Radiology-developed system, this text:

    Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office and you should contact your physician if you have any questions or concerns about this notice.

    Texas Gov. and Republican presidential hopeful Rick Perry signed into law a similar bill, Texas Act HB 2102, or Henda’s Law, in June. And breast density legislation was also passed in Connecticut in 2009.

    New Hampshire, Massachusetts, New York and Florida all have similar legislation pending.

    The American College of Radiology Imaging Network says that around 40 percent of women getting screening mammograms have dense breasts, with younger women typically having denser breasts.

    Dense breasts are less fatty, with more connective tissue. The connective tissue appears white on a mammogram, just like the cancer, making it harder to diagnose, according to Are You Dense, an advocacy group.

    A January 2011 study by the Mayo Clinic found three-quarters of cancers in women with dense breasts are missed by mammograms.

    “When it comes to your health, ignorance is not bliss. What you don’t know can hurt you,” State Sen. Joe Simitian, a Democrat from Palo Alto who authored the bill, said in a statement.

    The idea for the bill came from by Amy Colton, a registered nurse who had breast cancer not discovered by a mammogram, and who learned she had dense breasts only after her cancer was diagnosed, according to Are You Dense. She suggested the bill in Simitian’s “There Oughta Be a Law” contest.

    However, the bill met some opposition from the California Medical Association. Writing about an earlier incarnation of the bill, SB 173, the CMA warned that it could bring legal and practical problems for Calif. doctors.

    “Because the scope of who must receive the notice is so broad, women will be ‘scared’ into thinking they need these expensive additional screenings when it isn’t at all warranted, leading to increased costs and pressures on a physician’s practice,” the group wrote in a notice on its website. “Moreover, because the grading of the condition that may/may not lead to their receipt of the prescribed notice is subjective in nature, the absence of the notice could lead to lawsuits against doctors if a patient is later diagnosed with breast cancer.”

    But the bill was backed by several other groups, including the California Nurses Association, the Breast Cancer Fund, the California Association of Health Underwriters and California NOW.