The first of two studies conducted by nonprofit DenseBreast-info.org (DB-I) has revealed gaps in the knowledge that radiologists and radiologic technologists have about dense breasts and screening.

The study, which was based on the results of DB-I’s CME/CE course, “Breast density: Why it Matters,” found a lack of understanding among 200 radiologists and 1,300 radiologic technologists in regard to breast density, breast cancer risk assessment, and breast cancer screening. The report is titled, Radiologic Technologist and Radiologist Knowledge Gaps about Breast Density Revealed by an Online Continuing Education Course.

"The advent of density inform laws has resulted in new discussions between imaging teams and patients," Robin Seitzman, Ph.D., MPH, director of education and epidemiology research for DenseBreast-info.org, told HCB News. "There seem to be limited educational resources to prepare them for these density-specific conversations. There are also nuances that may be overlooked, such as the fact that tomosynthesis is not equally effective in extremely dense breast tissue as it is in other density categories, and that not all risk models are appropriate for all purposes."

The online CME/CT course included a collection of pre-course demographic information, a monograph based on DB-I content, and a post-test to assess knowledge.

Nearly half of surveyed physicians and technologists wrongly thought aging increases a woman’s lifetime risk of developing breast cancer, and about one-third overestimated the ability of tomosynthesis to detect cancer when they said it was nearly equal to MR. A third also incorrectly thought that the Gail risk model - which is used to estimate a woman's risk of developing invasive breast cancer over the next five years and up to age 90 - should be used to determine if a woman is high risk to the point where she should be recommended for MR or genetic testing. In addition, about one-third of physicians and about half of technologists were unaware that screening MR should be recommended for a 29-year-old woman if she has a family history of the disease-causing BRCA1/2 mutation(s).

Regarding breast density, 523 of 1,190 technologists erroneously believed the most commonly used risk model calculators included breast density as a risk factor. Those in practice for 10 years or less were more than 50% likely to believe this misperception than those practicing for more than 20 years. Physicians showed no knowledge gap here.

The findings according to Seitzman indicates that screening MR in high-risk women may be underutilized and that resources with complete information to fully inform and educate radiologists on proper screening assessment are essential to ensuring patients undergo the right diagnostic exam based on their personal risk profile.

"Targeted, comprehensive educational resources on breast density and supplemental screening are needed, as are clear national guidelines to address improved screening for women with dense breasts," she said. "With the Netherlands DENSE trial results and ECOG-ACRIN 1141, and several states now requiring insurance coverage for MR in women with dense breasts, this may include screening MR or contrast-enhanced mammography going forward. There is a great need to educate women directly, radiologists, technologists, and referring physicians about the limitations of current screening and supplemental options."

Legislation passed in 2019 requires all U.S. mammography reports to include up-to-date information on the density of a patient’s breast tissue. In accordance with the mandate, the FDA will develop reporting language on the topic and take steps to ensure mammography reports and summaries include necessary information about breast density when sent to patients and their providers.

"Both the breast imaging team and the referring provider are involved in a woman’s screening mammogram," JoAnn Pushkin, executive director of DenseBreast-info.org, told HCB News. "It is important to understand knowledge gaps among providers in both disciplines, as the patient will likely seek information from one or the other. In addition, referring providers often rely on recommendations made by radiologists; however, it is important that they are empowered make appropriate screening recommendations independently, as recommendations may not be included in the mammography report."

The second study will focus on identifying knowledge gaps among referring providers. It will also assess whether a medically sourced web-based educational intervention can bridge knowledge gaps and increase comfort levels in navigating patient discussions around breast density and its implications for breast cancer screening and risk.

The research was supported by DB-I’s Education Supporters. Funding was provided in part by a generous grant from the American Cancer Society.

The findings of the first study were published in the Journal of Breast Imaging.