A new Illinois law requires radiologists to inform patients about their breast density in the lay letter that is sent to each patient with the results of their screening mammogram. Illinois is the 36th state in the U.S. to pass a law about breast density notification, and the bill passed the state legislature with no opposition.
Northwestern Memorial Hospital’s Chief of Breast and Women’s Imaging Sarah Friedewald, MD, worked on the legislation, and here Dr. Friedewald explains what physicians need to know to ensure compliance:
Breast density refers to the amount of breast tissue in a woman’s breasts.
Radiologists categorize breast density into four categories: fatty, scattered, heterogeneous and extremely dense.
A woman is considered to have dense breast tissue if she falls into either the heterogeneous or extremely dense categories, which is approximately 50 percent of women.
Mammography is the only test proven to reduce mortality from breast cancer. However, it remains limited in sensitivity in women with dense breast tissue.
Supplemental screening with either MRI or ultrasound has been suggested as a complementary test to improve cancer detection, but there are high false positives associated with each test. MRI has significantly more cancers detected than ultrasound, with similar false positives.
Northwestern Memorial Hospital prefers to screen patients if they request supplemental screening with MRI. However, if the patient is scheduled for a screening ultrasound, the test will be performed. We are working on an abbreviated protocol for MRI, which would decrease the time necessary in the machine to approximately 10 minutes.
The American College of Radiology (ACR) is neutral on supplemental screening due to the high false positives. It is not included in the current practice guidelines, but the ACR would support the practice if the patient/physician requests it.
Both ultrasound and MRI are covered by insurance companies in Illinois (required by law, SB 0314) with a few exceptions (usually self-insured companies).
The language that will be included in the Northwestern Memorial Hospital lay letter is as follows:
Your mammogram indicates you have dense breast tissue. Dense breast tissue is normal and identified on mammograms in about 50 percent of women. Dense breast tissue can make it more difficult to detect cancer on a mammogram and may be associated with an increased risk for breast cancer. Despite these limitations, screening mammography is the only test proven to save lives. Therefore, please continue to have annual screening mammography. This information is provided to raise your awareness of the impact of breast density on cancer detection. For further information about dense breast tissue, as well as other breast cancer risk factors, contact the Lynn Sage Breast Center.
If you have any questions about the new law, please contact Dr. Friedewald at firstname.lastname@example.org or 312.472.0460.