The growing importance of breast density notification laws

Five years ago, the state of Connecticut became the first to require that women be told they have dense breasts and that insurance cover ultrasound scans for those women.

Since then, another 18 states have enacted similar laws, and Congress is considering similar legislation, as well.

We know that dense breast tissue, common in many women, can make it harder for radiologists to evaluate the results of mammograms and that it could also be associated with an increased risk of breast cancer.

But now, a new study in the Annals of Internal Medicine suggests that automatically giving women with dense breasts a supplemental imaging examination may not be the best course of action.

The study estimates that, for every 10,000 women between the ages of 50 and 74 with dense breasts who receive supplemental ultrasound screening after a normal mammogram, about four breast cancer deaths would be prevented, but an extra 3,500 biopsies would be given to women who did not have breast cancer.

The study "reaffirms that we don't know exactly what the right thing to do is when a woman has dense breasts," said Otis Brawley, chief medical officer for the American Cancer Society, in an interview with CBS News. He added that finding more tumors doesn't necessarily save lives, and that "we're legislating something that we don't totally understand."

Senior author Anna Tosteson, of Dartmouth Hitchcock's Norris Cotton Cancer Center and The Dartmouth Institute for Health Policy and Clinical Practice, believes the research is timely because "with existing breast density notification laws in some 19 states, and with national legislation pending, it is critical that we understand what approaches to supplemental breast cancer screening are most effective for women with dense breasts."

Ultrasound is but one supplemental screening modality. For example, breast MRI can be a useful tool for screening women with dense breasts, but is expensive and not widely available. However, the use of an abbreviated MR protocol suggests he possibility that MRI could be used for screening on a wide scale.

Clearly, Tosteson says, more studies are needed to determine what approaches to screening are going to be most beneficial.

That shouldn't, however, slow down the movement toward breast density notification laws. Some recent studies have shown that most adults worldwide are unaware of possible connection between breast density and cancer. That's something a well-designed breast density notification law can rectify. - Mike (@FierceHealthIT)