Mammograms don’t always pick up early cancers in women with dense breasts — a problem that a new Arizona law is seeking to address.
Arizona’s Mandatory Breast Density Reporting Law, which was sponsored by Arizona Sen. Nancy Barto, a Republican from Phoenix, took effect Oct. 1. Under the law, providers who administer mammogram screening must notify patients with dense breasts in the follow-up mammogram report.
Supporters of the legislation say the issue is particularly important because dense breasts are a risk factor for breast cancer.
But some medical experts worry that since so many women have dense breasts, the law could result in unnecessary and expensive testing and biopsies.
“It’s a little bit unusual a legislature would make these recommendations when they are not practicing medical professionals,” said Dr. Gary Wood, medical director at Northwest Women’s Imaging, which is part of Northwest Medical Center.
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Experts don’t agree on the best follow-up tests to a mammogram, but they do recommend women talk to their health provider about it, American Cancer Society spokeswoman Brittany Conklin said.
She said based on what we know today, women with dense breasts are only at a moderate risk for breast cancer, but that those with dense breasts and a high-risk gene mutation are advised to get an annual MRI as well as a mammogram.
Nineteen states, including Arizona, have enacted mandatory breast density reporting laws. Another 13 states are either working on breast density reporting laws or have already introduced legislation.
In Arizona, providers are required to tell patients that they have dense breasts in the summary of the mammography report.
The language in the notice to women that providers are to use is outlined in the law, and encourages women with dense breasts to have a discussion with their health provider. The notice says that 50 percent of women have dense breasts.
Four states have accompanying insurance coverage laws for women with dense breasts, but Arizona did not include an insurance stipulation in its law. That could pose a cost problem for women seeking elective follow-up screening.
Wood said women under the age of 50 have a higher propensity for dense breasts. But there are different levels of density, and women should not automatically consider it a reason for additional screening, he said. Other factors to take into account are family history and how the current mammogram compares to old ones.
“It also depends on how comfortable you are with where you got your mammogram,” he said. “Are they trying to create more business or are they really saying this patient needs another exam?”
Connecticut became the first state to pass a mandatory dense breast screening law in 2009.
The movement began with Nancy Cappello, a Connecticut woman with dense breasts who was diagnosed with Stage 3 breast cancer two months after receiving a normal mammogram report.
She beat her cancer, but not before six surgeries, five months of chemotherapy, and 24 radiation treatments. She went on to found the national nonprofit group, Are You Dense?
There is currently no national standard to disclose breast density to women, but a federal density reporting bill was introduced in both the Senate and House in July.
Northwest Women’s Imaging since May has been using 3D mammography for all patients getting a regular mammogram. The sharper technology gives a more clear and in-depth reading than a regular mammogram and is intended to cut down on the need for follow-up tests.
For those who still need additional screening, there are several options, including a traditional ultrasound that uses a hand probe and can give a closer look at breast tissue, but it’s time-consuming and very operator-dependent, Wood said.
The relatively new, “automated whole breast ultrasound” is more accurate than the traditional ultrasound, Wood said. His clinic expects to purchase the technology in the near future.
An MRI (magnetic resonance imaging) scan has its benefits but is very expensive, and a lot of people cannot get it covered by insurance, Wood said.
Northwest Women’s Imaging has another test using nuclear medicine, which requires a small injection, that is also very effective, he said.
