The Breast Density Notification Train is A-Rollin’

What started with a chug and a whisper is growing in both momentum and volume. Can you hear that whistle blowing?

For years, mammography has been the breast cancer screening standard of care for women over 40 and, to its credit, has saved countless lives by detecting breast cancer early enough to provide life-saving treatment. And, despite recent controversial studies that challenge the value of annual screening, or screening of women under 50, mammography has been, and will likely continue to be, the gold standard for breast cancer screening for years to come.  

There is, however, a growing population of women, healthcare providers and legislators who passionately believe mammography screening may not be the ideal solution for all women — particularly for those with dense breast tissue, where cancer is more difficult to detect. Looking for small, early-stage breast cancer in mammograms of this population has been likened to looking for a snowball in a blizzard. Cancer is being missed and these women are paying a high, and sometimes the ultimate, price.

The good news is there are several imaging modalities available today that may more effectively detect early-stage breast cancer in dense-breasted women, including magnetic resonance imaging (MRI), ultrasound or automated breast ultrasound (ABUS), molecular breast imaging (MBI) and breast tomosynthesis, to name a few. The bad news is, with these promising technologies come challenges, not the least of which is increased cost. Providers have been slow to adopt these modalities for initial (or adjunct) screening due to the upstart cost of obtaining the equipment, workflow, staffing and training issues, lack of reimbursement and other challenges. So women with dense breasts, or women with a history of breast cancer, are instructed to continue with annual mammograms — just like fortysomething-year-old women with no family history of breast cancer. One proverbial shoe fits all, at least for now.

While providers and payors grapple with the possibilities and challenges of personalized breast screening for women, there is a movement under way to inform women with dense breast tissue of their increased risk factors and screening options. Breast density advocates like Nancy Cappello, Ph.D., founder of Are You Dense, Inc., and JoAnn Pushkin, co-founder of D.E.N.S.E., have led the charge by increasing awareness in women who have, in turn, captured the attention of healthcare providers and lawmakers. Slowly but surely, it seems to be working. To date, 17 states (CT, TX, VA, NY, CA, HI, MD, TN, AL, NV, OR, NC, PA, NJ, AZ, MN, RI) have enacted mandatory density inform laws, six additional states (DE, KY, MA, MI, OH, and SC) have legislation pending and, in time, others will likely follow. Federal legislation is also in play. At the moment, over 50 percent of American women now live in states requiring some level of notification. The train has left the station and is gaining speed. 

Thinking out loud … I’d sure hate to be the governor of the final state to sign off on breast density inform legislation — wouldn’t you? 

All aboard!