UPDATED. Many states have laws on breast density notification after mammography screening – but not all notification is the same.
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Breast density notification laws have been put into effect in 30 states. Breast density notification laws vary but are intended to inform women who have undergone mammography about the risks posed by breast density.
The intent of such a law was to give women the necessary information to decide on further action if they had dense breast tissue. Dense breast tissue makes it harder to identify cancer on a mammogram and may also be associated with an increased risk of breast cancer, according to the American College of Radiology (ACR). Women with dense breasts are encouraged to discuss with their physicians their possible increased risk of breast cancer and the difficulty that mammography may have in detecting tumors. Critics of such a law or of how such a law is implemented believe that women may receive the information in less than ideal circumstances, which can lead to increased anxiety, as well as additional medical procedures.
“The manner in which the information is shared is important,” Richard Frank, MD, PhD, chief medical officer for Siemens Healthcare North America and founding member of the Quantitative Imaging Biomarkers Alliance of the Radiological Society of North America, told Diagnostic Imaging. “There might be value in not just sending a letter through the mail, but giving it to her. She then has an opportunity to actually talk about it.” In most cases, the letters are mailed, so the content of the letter is paramount. The letter’s text varies considerably across the states. Frank believes that women would be better served with a single informed letter issued from the federal level.
An example of ineffective language used in some states is one that raises more questions than it answers, according to Frank. Such letters say, “If you have dense breasts, and then what the options are. So the woman is going to look at that letter and say, ‘why did I receive this letter?’” It doesn’t tell her if she does or doesn’t have dense breasts, nor does it inform her of her particular situation, Frank explained. A letter that says “if” you have dense breasts, is a good example of one that might only raise concerns and not be helpful, he said.
For a more effective letter, Frank liked the one by physicians in Michigan: “It says, ‘your mammogram shows that your breast tissue is dense.' There is the opening line, a clear statement,” he stated.
“You’re receiving this letter because your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer through a mammogram” is a common explanation in some state’s notification letters. Frank pointed out that these lines explain why it might be a good idea for this woman to undergo other imaging techniques. “And then the letter goes on to say something else: also dense breast tissue may increase your risk for breast cancer.”
The letter continues: “‘This information about the results of your mammogram is given to you to raise your awareness. Use this information to talk to your physician.’ So now they are giving specific instructions for what you should do with this,” Frank said. “There is no question in the mind of the woman. ‘What is my status, what is there relevance and what should I do about it?’”
The first state to pass breast density notification legislation was Connecticut in 2009. Many states have followed since then. Check out our interactive map to see which states have passed breast density notification legislation (and their recommended text), what states are in process and what states haven’t approached the controversial topic yet.