Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment

Pranay Kothari; Joseph J Tseng; James S Chalfant; Sarah M Pittman; Anne C Hoyt; Linda Larsen; Pulin Sheth; Mary Yamashita; John Downey; Debra M Ikeda

doi:10.1093/jbi/wbac034

Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment

J Breast Imaging. 2022 Jul 29;4(4):371-377. doi: 10.1093/jbi/wbac034.

Authors

Affiliations

¹ Scripps Health, Department of Radiology, San Diego, CA, USA.
² Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA.
³ David Geffen School of Medicine at University of California Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA.
⁴ University of Southern California, Department of Radiology, Los Angeles, CA, USA.
⁵ Kaiser Permanente Medical Center, Department of Radiology, Walnut Creek, CA, USA.

PMID: 38416983
DOI: 10.1093/jbi/wbac034

Abstract

Objective: To evaluate breast density notification legislation (BDNL) on breast imaging practice patterns, risk assessment, and supplemental screening.

Methods: A 20-question anonymous web-based survey was administered to practicing Society of Breast Imaging radiologists in the U.S. between February and April 2021 regarding breast cancer risk assessment, supplemental screening, and density measurements. Results were compared between facilities with and without BDNL using the two-sided Fisher's exact test.

Results: One hundred and ninety-seven radiologists from 41 U.S. states, with (187/197, 95%) or without (10/197, 5%) BDNL, responded. Fifty-seven percent (113/197) performed breast cancer risk assessment, and 93% (183/197) offered supplemental screening for women with dense breasts. Between facilities with or without BDNL, there was no significant difference in whether risk assessment was (P = 0.19) or was not performed (P = 0.20). There was no significant difference in supplemental screening types (P > 0.05) between BDNL and non-BDNL facilities. Thirty-five percent (69/197) of facilities offered no supplemental screening studies, and 25% (49/197) had no future plans to offer supplemental screening. A statistically significant greater proportion of non-BDNL facilities offered no supplemental screening (P < 0.03) and had no plans to offer supplemental screening compared to BDNL facilities (P < 0.02).

Conclusion: Facilities in BDNL states often offer supplemental screening compared to facilities in non-BDNL states. Compared to BDNL facilities, a statistically significant proportion of non-BDNL facilities had no supplemental screening nor plans for implementation. Our data suggest that upcoming federal BDNL will impact how supplemental screening is addressed in currently non-BDNL states.

Keywords: breast cancer; breast density; breast density notification laws; breast ultrasound; mammography; screening.