How density notification laws have impacted the use of supplemental imaging
Nearly two years after official breast density notification laws went into effect in the United States, a new analysis is revealing how the mandate has changed supplemental imaging utilization.
Published in JAMA Network, the study explores how breast ultrasound and MRI deployment has evolved since 2024 among women with dense breasts. While density notifications have improved supplemental imaging use, researchers determined, insurance coverage remains the biggest factor impacting patients’ decision to undergo additional imaging.
Prior data suggests that density notification laws have increased supplemental imaging uptake, but these changes occurred mostly in states where insurance coverage was mandated. This prompted researchers to explore how new notification requirements hold up amid varying levels of insurance coverage across the U.S.
“Despite these increasing legislative efforts, there remains a lack of clinical evidence, especially for insurance coverage laws. Our study addresses this limitation by distinguishing between notification and insurance coverage laws across multiple states over a longer time period and by evaluating how specific legislative features are associated with use of supplemental imaging, using a large nationwide cohort of women undergoing screening mammography.”
The group analyzed insurance claims from 12.6 million women ages 40 to 64 who underwent screening mammography between 2008 and 2019; using that data, they evaluated how state dense breast legislation influenced the use of supplemental ultrasound and MRI within six months of screening.
The team found that notification laws were associated with a modest increases in both supplemental exams. Insurance coverage mandates, however, had a substantially greater effect, nearly doubling the odds of supplemental ultrasound use. Legislation that informed women about supplemental screening options and laws that targeted notifications only to women with dense breasts were associated with the highest rates of ultrasound use.
These findings suggest that “coverage provisions may be more strongly associated with imaging uptake than notification alone.”
“Although notification laws may raise awareness, insurance coverage may be necessary to translate awareness into action,” the authors concluded.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.