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 Laws that only require women to be told they have dense breasts,
without any further information, don't seem to make a difference in
extra screenings or cancers detected, the study team reports in
American Journal of Public Health.
Roughly half of U.S. women in their 40s and 50s have dense breast
tissue, which increases their risk of breast cancer and makes it
harder to detect tumors with mammography. Several states require
healthcare providers to send notification letters to women whose
mammograms show dense breast tissue. Some states also require that
these higher-risk women be advised to get screened with ultrasound
or MRI, which can better detect tumors in dense breast tissue.
A new proposal from the U.S. Food and Drug Administration, announced
March 27, would require all mammography facilities in the U.S. to
include breast density information in letters to patients. The FDA
says it is proposing "specific language that would explain how
breast density can influence the accuracy of mammography," but the
agency's announcement does not say the letters must advise about
further testing options.
For the current study, researchers examined data on screening and
cancer diagnoses for more than 1.4 million women ages 40 to 59 in
nine states with dense breast notification laws and 25 states
without these laws.
"We found that dense breast notification laws were associated with
small increases in cancer detection," said lead study author Susan
Busch of the Yale School of Public Health in New Haven, Connecticut.
"This effect was only found in states with laws that included
language about the benefits of supplemental testing," Busch said by
email. "We did not have enough follow-up data to take the next step
and determine whether dense breast notification laws were associated
with reduced breast cancer mortality."
The goal of mammograms is to detect tumors before they can be felt
in a physical breast exam, catching cancer sooner when it's easier
to treat. Ideally, this should mean fewer women are diagnosed when
tumors are more advanced.
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It's not clear from the current study to what extent dense breast
notification laws might lead to so-called over-diagnosis, which can
cause women to undergo needless testing or treatments for relatively
harmless tumors; it's also not clear how many lives might be saved
by catching aggressive cancers sooner when they're easier to treat.
Very few women in the study got recommended ultrasounds after
screening mammograms found dense breast tissue, even though
insurance covers these tests, the researchers note.
Women with dense breasts should continue to get mammograms and
should also speak to their doctor to determine what screening plan
is best for them, advised Dr. Catherine Tuite, chief of breast
radiology at Fox Chase Cancer Center in Philadelphia.
"Mammography is still the gold standard for the detection of breast
cancer, even for women with dense breasts, and multiple studies have
proven that detection of cancers by mammography reduces the risk of
death due to breast cancer for women starting at age 40," Tuite, who
wasn't involved in the study, said by email.
"Women diagnosed with breast cancer who participate in screening
mammography are less likely to die from breast cancer than those who
do not," Tuite added. "Supplemental screening tests such as
screening whole breast ultrasound, MRI or MBI are not a substitute
for mammography because there are still some cancers and
precancerous changes that will show on a mammogram better than on
other tests."
SOURCE: https://bit.ly/2V6ww4I American Journal of Public Health,
online March 21, 2019.
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