Why breast density notification laws are good public policy

In an article in the December issue of the Journal of the American College of Radiology, Nancy Cappello, Ph.D., who is a breast cancer survivor, makes the argument for why density notification laws make for good public policy.

In Cappello's case, a 2.5-cm mass was found through a clinical breast examination by her physician, which was confirmed by ultrasound. This was after a mammogram found nothing. She was diagnosed with Stage III breast cancer that metastasized to 13 lymph nodes.

After her diagnosis, Cappello launched an advocacy group called Are You Dense, which was instrumental in getting the nation's first breast density notification law passed in Connecticut in 2009. Similar legislation has since been passed in another dozen states and federal legislation is under consideration.

As reported in an article in AuntMinnie.com, the move toward passing breast density notification legislation hasn't been uncontested, with some breast imaging specialists afraid it poses an administrative burden on imaging practices and represents "a slippery slope" of government involvement in medical practice.

In the article, Cappello refutes arguments against mandatory breast density notification, such as that it can lead to patient anxiety or confusion, or even dissuade women from getting mammograms in the first place.

She also suggests that while there's a lot of evidence supporting the role that breast density plays in missed cancers on conventional X-ray mammography--and that this evidence is known by breast health physicians--that information is often not communicated to patients unless mandated by legislation.

"All the issues that are concerning to the profession cannot be solved by withholding a woman's dense tissue composition from her," Cappello wrote. "Her breast health and access to an early diagnosis are compromised by delaying this communication. Short of a MQSA regulatory change or a national law, our work with patients and physicians for mandated density disclosure through state legislation will continue."

To learn more:
- here's Cappello's JACR post
- see the article in AuntMinnie.com
- read about Are You Dense

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