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Breast density notification, knowledge, and next steps

July 11, 2022
Women's Health
From the July 2022 issue of HealthCare Business News magazine

By Rebecca E. Smith

The U.S. Food and Drug Administration (FDA) proposed updates to the Mammography Quality Standards Act (MQSA) of 1992 that will require radiology facilities to provide breast density notifications to women. Dense breast tissue makes it difficult to see cancers on a mammogram and dense breasts also put women at higher risk for breast cancer. Notification aims to provide women information to support conversations with their healthcare providers about their personal breast cancer risk and screening options. However, there is not clear clinical guidance on when and with whom to discuss imaging that is supplemental to mammography, because evidence is still evolving about the benefits of supplemental imaging, given various cancer risk scenarios; and breast cancer screening guidelines differ in recommendations for women with dense breasts. For example, the American College of Radiology recommends magnetic resonance imaging (MRI) in addition to mammography for women with dense breasts while the U.S. Preventive Services Task Force states there is insufficient evidence to recommend MR or other supplemental screening for women with dense breasts whose screening mammogram was negative.

While we await release of the detailed MQSA updated rule, existing state density reporting laws and policies remain in place. Understanding the effectiveness of existing policies for informing women of their breast density, and their impact on cancer worry and future screening intentions is informative in both the development of federal notification language and support tools for clinicians who will need to engage patients in conversations about breast density and cancer risk.

In 2009, Connecticut was the first state to pass breast density notification legislation. Currently 40 states have implemented some form of legislation or policy focused on density education with some set to expire in less than 1 year. There is no standard legislated content between states. For example, some states require only general information be given about breast density but do not require a woman to be informed of her personal density. Other states include language to encourage women with dense breasts to engage in further conversation with their providers about their personal cancer risk and screening options. While some states require density information be sent to all women (with both dense and non-dense breasts), and some send information to only those with dense breasts.

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