The case for state-level dense breast laws: Increased awareness, patient-physician conversation
State-level breast density reporting laws are associated with increased breast density awareness and increased likelihood of conversations between women and their providers regarding supplemental screening, according to research published in the Journal of the American College of Radiology.
“Our national survey demonstrates that density reporting laws are associated with increased breast density awareness and higher rates of conversations between women and their providers regarding supplemental screening,” wrote lead researcher Nancy Cappello, PhD, of advocacy groups Are You Dense, Inc., Are You Dense Advocacy, Inc., and colleagues. “Although most women are now familiar with the masking effect of dense breasts on mammography, they are less aware of density’s inherent increased breast cancer risk.”
A total of 36 states have enacted density reporting legislation since 2009. While advocates have welcomed this legislation, opponents have criticized the laws’ readability, a lack of uniformity across states, potential for additional costs and overdiagnosis, physician unpreparedness and patient and provider confusion.
Cappello and colleagues conducted a national survey on women’s level of density risk awareness and their engagement in conversations with providers regarding supplemental screening.
About 1,500 women between the ages of 40 to 74 who received a mammogram within two years were surveyed in Feb. 2018.
The cohort had 300 respondents in five different groups: Connecticut (first state to mandate all women undergoing screening receive information about dense breast tissue); everyone, no density (five states where all women undergoing screening receive dense breast tissue information); only dense (16 states where only women with dense breasts receive information about dense breast tissue); everyone, dense breast (nine states where all women undergoing screening receive information about own density category); and no-law (19 state with no density reporting law as of February 2018).
The groups were were based on law details between women residing in states with laws versus those without laws, according to the researchers.
Women were surveyed about their knowledge related to breast density, the importance of being notified, sources of information and if they participated in conversations with providers regarding density and supplemental screening. Survey results were compared across groups and between women residing in states with density laws versus without.
The researchers found the following:
- Between 67 to 80 percent of women in all groups knew that dense breasts may mask cancers on mammography; however, fewer than half of the respondents in four of the five sample groups knew that dense breasts are a risk factor for developing breast cancer.
- About 85 to 90 percent of respondents in all groups, completely or mostly agree that they would prefer to know their breast tissue type than not know.
- Women from states where density reporting laws have been in place for a longer period of time are more likely to know their density type and are also more likely to report their provider spoke to them about supplemental screening.
- About 68 to 71 percent of women said their clinician informed them of their tissue type. And 46 to 61 percent of women noted they were informed of their tissue type from their radiologist.
A key strength of the study was the diverse distribution of sociodemographic characteristics across all sample groups and included women from states with and without density reporting laws, varying languages, statues and durations of the reporting laws. The sample size allowed for near perfect confidence levels, according to the researchers.
“Moving forward, patient advocacy groups should advocate for more refined and personalized information about a woman’s specific breast tissue category, associated risks, and discussions regarding supplemental screening,” the researchers concluded.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.