An Expert Discusses Breast Density Notification Laws

Determining Cancer Risk

Medscape: You mentioned risk assessments. Can you describe that process?

Dr. Monticciolo: Breast cancer risk is multifactorial. So for any individual patient, just having dense breast tissue may not really change what she needs to do. Our concern is that many women will be told that they have dense tissue, without distinguishing how dense and without a clear indication of their own individual risk.

Right now, patients with heterogeneously dense and dense tissue get lumped together, but the effect of density is much less for those in the former category (heterogeneously dense). Patients feel like they absolutely must have further testing. What we're suggesting is they talk to their doctor and look at their overall risk, because density is only 1 element in a risk profile.

The Texas law gives us room on how to take the next step, and we're trying to do what is best on the basis of current science.

Risk assessment looks at other things -- family history, personal history, history of biopsy with certain types of pathology -- things that we know increase a patient's risk of getting breast cancer. At Scott and White, we have a high-risk clinic, and we have a physician who specializes in making these kinds of assessments. There are many risk assessment models available that have been validated in many different patient populations. Using these models, a physician can determine what a patient's lifetime risk is and suggest strategies to minimize the risk.

That's how we are using the breast density law. We treat density as 1 element, and we tend not to push patients toward ultrasonographic screening if they're on the low end of heterogeneously dense. The Texas law gives us a little bit of room to interpret how to take the next step, and we're trying to do what we think is best for the patient on the basis of current science.