10 Years Later: Dense Breast Notification Letters Result in Higher Supplemental Ultrasound Screening

Ten years after Connecticut passed the first breast density notification law, approximately three-quarters of women with dense breasts now opt to undergo supplemental whole-breast ultrasound screening.

In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Liane Philpotts, M.D., FACR, professor of radiology and biomedical imaging at Yale School of Medicine, outlined her department’s experience with breast density laws.

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Currently 38 states have breast density notification laws, and a federal law is anticipated soon. Her department started offering screening whole-breast ultrasound (WBUS) in 2009 with the state first passed the law.

“Our policy has been to inform women of density (as per Connecticut law) and offer, but not explicitly recommend WBUS, leaving it to the patient and provider to decide,” said Philpotts, who is also section chief of breast imaging.

To help practices in the early stages of adopting supplemental screening, her team assessed the percentage of women with dense breasts who have opted to undergo supplemental WBUS.

By searching an electronic breast imaging database, Philpotts team identified women with dense breast tissue who had screening mammography performed at either a main academic tertiary hospital or three outpatient satellite offices. They also identified women who underwent bilateral WBUS after a normal, same-day screening mammogram. They compared the number of patients from July 1 to July 31 of each year between 2010 and 2019.

Based on her team’s analysis, screening mammography volume increased 3.5 times across practice sites over the decade. The first year, only 18 percent of women underwent WBUS, but the increase was steady on a year-by-year basis, growing to 28 percent by year two and climbing all the way to 75 percent each year of the past few years, she said.

These results show that the dense breast notification laws could be having some positive impact, she said.

“While initial uptake was low, after a few years, the majority of women with dense breasts undergoing mammography also undergo WBUS,” she said. “This suggest the acceptance of the supplemental screening test is high among both providers and women.”

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