Lara C. Pullen, PhD

November 30, 2011

November 30, 2011 (Chicago, Illinois) — Since October 1, 2009, all mammography reports in Connecticut must include a letter alerting patients if they have heterogeneously dense or dense breasts. This has resulted in enhanced cancer detection, along with a high false-positive rate and a higher number of biopsies, according to researchers.

The cost of this policyis estimated to be approximately $110,000 per cancer found.

Two posters on the Connecticut experiment were presented back-to-back here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting. Christine Kim, MD, from the University of Connecticut at Farmington, presented the first poster, which described a retrospective analysis of screening mammograms performed since Connecticut Substitute Senate Bill 458 went into effect.

Dr. Kim and colleagues reviewed 2000 screening mammograms, and found that 416 of the women (20.8%) had heterogeneously dense or very dense breasts. Only 70 of the 416 women (16.8%) returned for a screening breast ultrasound. Screening breast ultrasound accounted for 31% of the total biopsies performed, which resulted in the detection of 1 additional malignancy.

Dr. Kim told Medscape Medical News that she and her colleagues do not know what drives patients' decisions to obtain or decline further screening with ultrasound. Future research will address this, as well as the role of the primary care physician: "We need to see what physicians are doing with these letters."

Stamatia Destounis, MD, from Elizabeth Wende Breast Care in Rochester, New York, discussed the study results with Medscape Medical News. She noted that the false-positive rate for the screening ultrasound was greater than 90%, explaining that this is "interesting work, but only a small number had the additional ultrasound exam.... [We] need a larger study to [determine whether] the cancer detection will add benefit to offset the false-positive value."

The second poster was presented by Sarah Steenbergen, MD, from the University of Connecticut School of Medicine in Farmington. Her study also found that screening breast ultrasound in women with dense breasts detects mammographically occult malignancy.

Dr. Steenbergen's retrospective chart review involved 78,778 screening mammograms and 8651 screening ultrasounds done over the course of 1 year (October 2009 to October 2010). This study was larger than the study by Dr. Kim and colleagues, and found that 50% of women with dense breasts received follow-up ultrasound. The study identified an additional 28 cancers found on biopsy after screening ultrasound.

The poster session was attended by a large number of physicians and by 2 breast cancer survivors with dense breast tissue who advocated for the Connecticut legislation. Donald Bachman, MD, from Metrowest Radiology Associates in Framingham, Massachusetts, attended both presentations and acknowledged that it is difficult to form a conclusion about whether such legislation is supported by science. He explained to Medscape Medical News that "different people look at that data and come up with different conclusions."

Mammograms classify breast density using the American College of Radiology Breast Imaging Reporting and Data System. Patients in Connecticut who have heterogeneously dense or dense breasts receive a notice stating: "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening or breast MRI examination, or both, depending on your individual risk factors."

Patient advocates are working to extend such a law throughout the United States. According to the Are You Dense? Web site, legislation to inform patients about breast density has been passed in Connecticut and Texas, and bills are currently being written in 11 other states.

Dr. Kim, Dr. Steenbergen, and Dr. Bachman have disclosed no relevant financial relationships. Dr. Destounis reports being an investigator with Siemens AG, Fujifilm Holdings Corporation, and Hologic, Inc; and being on the advisory board at Koning Corporation, Koninklijke Philips Electronics NV, and Matakina International Limited.

Radiological Society of North America (RSNA) 97th Scientific Assembly and Annual Meeting: Abstracts LL-BRS-MO3A and LL-BRS-MO5B. Presented November 29, 2011.


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