Virginia lawmakers have voted on an amendment that strengthens the density notification for women during regular mammography screenings.

The Virginia law, which was originally signed into law by Governor Bob McDonnell in 2012, was amended earlier this month to underscore the cancer risk breast density presents to women. It's modeled after laws in New York and California.

According to patient advocates, effective density notification should clearly tell a woman that she has dense breast tissue, which can interfere with the effectiveness of a mammogram. Besides discussing risk factors, doctors should also inform patients of the benefits of further screening, like ultrasound.

On a mammogram, dense breasts have less fat and more connective tissue, which appears white on the mammogram, just like cancer, possibly making it easy for radiologists to miss. Studies have also shown that women with dense breast tissue have a higher rate of breast cancer, the Centers for Disease Control and Prevention even include it on its list of "Risk Factors" for the development of breast cancer. However, to date, no evidence points to breast density being linked to increased cancer deaths.

"I felt density notification, which did not include mention of density as a risk factor, was insufficient. This amendment now gives VA women a more complete understanding of their density and its inherent risks, and it lets them know that they can discuss further screening with their physicians," said Virginia advocate, Cathy Tatusko, in a statement. JoAnn Pushkin, co-founder of D.E.N.S.E. (Density Education National Survivors' Effort) and founder of D.E.N.S.E. NY told DOTmed News that Tatusko fought long and hard for this language originally, but faced steep opposition. Breast density laws are somewhat controversial because the medical community is still unsure about what constitutes density and the best method for detecting it.

Language in the Virginia law has been changed from: "Your mammogram demonstrates that you may have dense breast tissue," to "Your mammogram demonstrates that you have dense breast tissue." The original law also made no mention of breast density as an independent risk factor. The amended law informs a patient that density "May also be associated with an increased risk of breast cancer."

Connecticut was the first state to pass legislation in 2009, followed by Texas, Virginia, California and New York in more recent years. Bills have also been recently introduced in Ohio and the unincorporated U.S. territory of Guam.

The Virginia amendment becomes effective on July 1, 2013.

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