Breast Density Update!

On April 5, 2018 Wisconsin became the 35th state to pass breast density legislation. The bill was authored by state Representative Mike Rohrkaste (R-Neenah) at the request of a constituent who was diagnosed with advanced breast cancer after dense tissue masked the tumor on her mammogram.
 
The Wisconsin Radiological Society was approached by Rep. Rohrkaste to provide medical background information. The WRS’s position was to remain neutral on the legislation, but anticipating a strong likelihood that it would pass, WRS continued to be involved throughout the process, testifying at the Assembly hearing on both the pro’s and con’s of breast density legislation. The result of our efforts is a bill that requires patient notification but minimizes institutional burden and prevents more prescriptive language.

Facilities that perform mammograms will need to include language that is substantially similar to the following in, or along with, their MQSA required patient lay letters. This notification requirement only applies to patients with heterogeneously dense breasts or extremely dense breasts (BI-RADS density categories C and D):

Sample language from the bill:
Your mammogram shows that your breast tissue is dense. Dense breast tissue is found in almost 40 percent of women and is a normal finding. However, studies show that dense breast tissue can make it harder to find cancer on a mammogram and is associated with a slightly increased risk of breast cancer. Regular screening mammograms are still recommended for you. This information is provided to raise your awareness about the result of your mammogram. You can use this information to talk with your health care professional about your own risks for breast cancer. Together, you can decide which screening options are right for you. The results of your mammogram were sent to your doctor. Please note that breast density is affected by several factors and may change over time.

Patients will be looking for guidance as they begin to receive this notification. Primary care providers will bear some of the logistical brunt of the new law, as women contact them to better understand this information.  Radiologists can offer value directly to patients and to our referring providers by sharing clear information about dense breast tissue and by anticipating questions on supplemental screening tests. To do this well, we have gathered some resources that will help you and your practice to be compliant with the law and valuable to your patients and referring providers.
 
Patients looking for more information on dense breast tissue will find countless resources online. A few well-written resources are listed below. 

Patient Resources:
•   ACR Brochure
•   Are You Dense?
•   Breast Density Info
•   Mayo Consumer Site
•   Dense Breast Info
 
One of the primary questions you can anticipate from clinicians is whether any supplemental screening is recommended. Currently, there is insufficient evidence to support the routine use of additional screening tests beyond mammography in women whose only risk factor is dense breast tissue.  The links below can help determine which patients may benefit from supplemental screening and can assist you in conversations with your referring providers.

Resources for Clinicians:
•   Clinical Scenarios
•   FAQs About Breast Density
•   Breast Density Info
 
If you would like to delve deeper in to the topic of breast density from a radiology perspective, the following links are a useful starting point. 

Resources for radiologists:
•   Mammographic Breast Density: Impact on breast cancer risk and implications for screening
•   ACR Position Statement on Breast Density
•   ACR Position Statement on Higher-Risk Women
•   Supplemental Screening for Breast Cancer in Women with Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force