Differences in Breast Density Awareness, Knowledge, and Plans

We read with interest the article by Kressin et al..¹ The study sought to determine the effects of state dense breast notification (DBN) laws on patient awareness relating to topics of masking, risk, and supplemental screening. One caveat is that not all 38 state laws² provide the same information or level of notification. It would have been informative if the study had distinguished between state DBNs that do provide personal notification and information on masking, risk, and supplemental screening vs. those that do not. For instance, six states (CT, TX, MD, NJ, MO, LA) require general information about breast density be provided to the patient without informing the patient if she, herself, has dense breasts. We hear from women in those states who assume they do not have dense breasts as the notification received does not detail that they do. Additionally, while all state laws except CT’s mention density as a (at least potential) risk factor, six state laws (CA, NV, SC, CO, WA, NM) do not provide unambiguous language about the masking effect of cancers due to dense tissue, and 23 state laws do not mention that supplemental screening may be a topic to discuss with a health provider. Some (e.g., UT, CA, MD, NV, NC) mention the ambiguous term “screening options” which women often interpret as mammography screening frequency.

DBN wording differences are acknowledged within the study’s “Discussion” section. To understand the impact of personal notification, an analysis of state inform laws that do provide full information in the form of personal notification of density and information on masking, risk, and supplemental screening, compared to states with no DBN, would be helpful.

In March 2019, the Food and Drug Administration (FDA) proposed updates to the Mammography Quality Standards Act (MQSA) that would require breast density reporting from all mammography facilities to both patients and healthcare providers. As recognized experts on density inform law analysis, DenseBreast-info, Inc. provided detailed input to the FDA on the proposed reporting language.³ The FDA’s introduction of a national reporting standard will only increase the need for medically sourced educational materials on the topic and it is the reason DenseBreast-info.org (DB-I) was developed and launched in 2015.