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John R. Fischer, Senior Reporter | July 02, 2018
Cappello believes delays in incorporating these measures and the fact that no national law on breast density is in effect partially fall on the medical community for not showing greater support and speaking up about the issue.
“Radiologists, the Radiology Society and the Society of Breast Imaging haven’t come out in support of breast density legislations and haven’t even come out to tell doctors to just tell women and report it whether you have a state law or not,” she said. “Even if a woman knows she has dense breast tissue, it does not necessarily mean that she’s having informed conversations with her doctor.”
Conducting an exam using automated breast ultrasound
Senator Dianne Feinstein and Dean Heller introduced the Breast Density and Mammography Reporting Act of 2017 to the Senate floor in November to pave the way toward nationwide breast density legislation. A House counterpart is also being evaluated. In addition, new FDA commissioner Scott Gottlieb has promised to change breast density regulations as part of his 2018 plans. Both have instilled newfound optimism in Cappello.
“My hope is to change the MQSA, maybe through the FDA or with a national bill,” she said.
Emerging technological advantages
Two-dimensional mammography is considered the gold standard for breast cancer detection due to its low-dose X-ray nature and ability to produce high-quality images in shorter exam times. But with its reduced ability to detect lesions within dense breast tissue and the development of new and innovative technologies, experts are beginning to wonder if a better way for detecting cancer is on the way here.
Conant believes that tomosynthesis (or 3D mammography) is a significant improvement over 2D mammography due to fewer false positives and increased cancer detection. Synthetic 2D imaging with tomosynthesis allows the X-ray dose to be lower than imaging with a combination of 2D plus tomosynthesis.
She also believes the development of emerging technologies such as AI will help improve both the presentation of the image data and the detection of cancers. AI technologies have the potential to help the radiologist interpreting studies by improving both cancer detection and the efficiency of reading studies, even in dense, complex breast tissue patterns. Even tomosynthesis though will not find all cancers, since it is just an X-ray based exam without contrast.
JoAnn Pushkin
Clarification on reporting requirements for density inform laws
July 06, 2018 05:43
Thank you for highlighting the progress of state breast density inform legislation. If we may make one important clarification, not all of the 34 active density inform laws require a woman be provided information about her own breast density. Some states (eg. CT, TX, MD, NJ, MO and LA) require women be provided only general information about breast density - without information as to whether they have dense breasts or not. For legally-vetted legislative analysis of state density inform laws, please visit DenseBreast-info.org/Legislative Info or click on table: Comparative Analysis of State Density Inform and Insurance Efforts: http://densebreast-info.org/img/table.laws.insurance.6.15.18.pdf.
DenseBreast-info.org is an education resource developed to provide breast density information to both patients and health care professionals (including a CME/CE opportunity on the subject) and is the collaborative effort of world-renowned breast imaging experts and medical reviewers. Thank you.
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