An Expert Discusses Breast Density Notification Laws

Published Data on the Laws Are Scarce

Medscape: Except for the study in Radiology and a counterpoint editorial in the same issue,^[2] I haven't seen much of anything in the literature discussing breast density notification laws. Does this surprise you? Has there been a very robust discussion of this topic nationally?

Dr. Monticciolo: It's certainly on the national radar. I think it will take time for actual data to come out on this topic. Right now, it's probably a little bit soon for well-planned and well-documented studies to be in print.

The density law in Connecticut was first, so it's nice that somebody is presenting data from that state. There has been a national dialogue, but at this point it's not based on data because there are very few data on the overall effects of these laws, both positive and negative.

There has been some national discussion. I'm on the US Food and Drug Administration's National Mammography Quality Assurance Advisory Committee, and this type of notification has been discussed. There certainly is dialogue going on, but there isn't much dialogue at this point in the scientific literature because there aren't enough data to have that discussion.

Medscape: On balance, do you think laws like this are a good idea, and where do you think most breast imagers would fall on this issue? If there is a division, what are the main points of contention?

The risk/benefit ratio is probably the main point of contention.

Dr. Monticciolo: I think the risk/benefit ratio is probably the main point of contention. Better information for our patients is always a good idea, so I strongly support that. Whether that should be in the form of a law for me is not clear. Laws are tricky when it gets down to the actual wording, and even if you think you know what the intent is, the way in which a law is worded can lead to unintended consequences.

In this case, I think the laws are ahead of the science because we don't have really enough information on this whole topic to be making the kind of decisions the laws are already making for us. Unfortunately, many of the laws are unfunded mandates, which is unhelpful. These are the downsides of bringing this into legislation before we really have a good handle on all the aspects of the issue.