Connecticut's Dense Breast Legislation Three Years Later

Connecticut launched its law mandating providers alert women if they have dense breasts and offer supplemental ultrasound screenings three years ago. The road has been rocky - radiologists initially resisted it, the density legislation confused many patients, and few women seemed interested in the secondary scans. But new research shows the law has resulted in more cancers found.

Much discussion surrounded Connecticut’s dense breast tissue law when it passed in 2009, requiring referring physicians to inform women with dense breast tissue that they could benefit from supplemental ultrasound screening. A recent study revealed the law had a slow, but effective, start.

In research published in the October issue of Radiology, investigators from Yale University determined less than 20 percent of women with dense breast tissue opted to have an ultrasound screening after receiving abnormal mammogram results. The retrospective review analyzed the ultrasound results for nearly 1,000 women who underwent the procedure.

Although fewer women than anticipated opted for ultrasound screenings after the law took effect, lead study author Regina Hooley, MD, assistant professor of diagnostic radiology, said giving patients the option of supplemental ultrasound screening after a mammogram was useful. Based on data pulled from the legislation’s first year, her team found additional 3.2 cancers per 1,000 women were discovered using ultrasound.

“These findings are right in the ballpark for the amount of cancers we identify with mammogram,” Hooley said. “Although mammography is the only test with data to show it reduces breast cancer-related mortality, it’s clear, with this study, that ultrasound provides an acceptable cancer detection rate at an acceptable cost.”

In January, Texas enacted its own version of the law, known as Henda’s Law. And, the American College of Radiology anticipated 13 additional states introducing some type of similar legislation during 2012.

According to the study’s cost analysis, each cancer identified via ultrasound cost approximately $60,000. That figure equals roughly $200 per patient, Hooley said. It’s also important to note that Connecticut insurance companies are required, under law, to cover these supplemental ultrasound screenings.
Connecticut radiologist Jean Weigert, MD, who serves as treasurer for the Radiological Society of Connecticut, also tracked supplemental ultrasound screenings in her practice. Her results, she said, are exactly the same as Hooley’s.

“It is statistically significant because we’re doubling the four to six cancers per 1,000 women we find with mammogram,” she said. “So, when we saw that data, that’s when we starting pushing patients, telling them this was a good idea, and they needed to do it.”

Hooley’s study is unique, however, because it analyzes test results from technologist-run, rather than radiologist-run, scans. The outcomes indicate that technologists, when given proper training, can perform ultrasound screenings with the same expertise and effectiveness as radiologists.

Having technologists run the ultrasound screenings is beneficial, she said, because the test is time consuming, often lasting up to a half hour per scan. A practice or department can provide care for more patients if technologists take over this responsibility. But it’s important, she said, for a radiologist to be on-site in case a technologist has a question about something that shows up during the test.

Both Hooley and Weigert agreed the study results are encouraging. But providers and patients must be cautious and remember that ultrasound screening is meant only to complement mammogram and, in no way, replace it. It will also require great collaboration within the industry to determine how to maximize the effectiveness of both exams.

“There’s not a lot of science on screening ultrasounds. No studies that show it’s directly responsible for reducing breast cancer mortality, but it has been shown to pick up additional cancers,” Hooley said. “We need to work more together in the future with physicians, advocacy groups, and legislators to figure out how best to screen our patients and how best to offer additional supplemental screening exams.”