Breast Density War of Words Heats Up Online

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With breast density inform laws under consideration in 10 states as well as by the Federal government, the recent cautious notes sounded by the ACR and the Society of Breast Imaging (SBI) were decidedly unwelcome to patient advocacy group Are You Dense.

Yesterday, the group posted a response to the ACR and SBI’s recent press release highlighting a study published in the Journal of the National Cancer Institute that found that although women with mostly dense breast tissue are at a small increased risk of developing breast cancer compared with women with mostly fatty breast tissue, women with dense breast tissue are not at increased risk of dying from breast cancer when compared to women with mostly fatty breast tissue.

The press release, which led to a widely circulated USA Today story, could cloud the argument for legislation to require informing women of their breast density status and additional screening options besides mammography. In particular, it could endanger the group’s argument for requiring insurance coverage for supplemental screening methods, such as ultrasound and MRI.

Are You Dense especially took issue with Barbara Monsees, chairwoman of the ACR's breast imaging commission, telling USA Today that laws like the recently passed New York state breast density inform legislation may be premature because research has not yet determined if additional screening is beneficial enough to justify the costs in both dollars and patient risks for increased false positives.

Are You Dense contends that although the research study found no increased risk for women with dense breasts dying, it was a false comparison because the researchers measured the risk of death by the stage of cancer the women were diagnosed at. Density inform advocates believe that dense breast tissue that hides tumors leads to later diagnosis, and this increases the risk of dying. Research comparing the risk of dying among women with either early or late stage cancer is therefore more relevant.

For its part, the ACR and SBI point out that mammography is still the only research-proven test that reduces breast cancer deaths. They support women speaking with their doctors about their risk factors “to fully explore available options” and recently issued their own patient brochure about breast density for radiologists and primary care physicians to use in these discussion. (Click here to download the PDF.)) They just don’t support legislation that specifically tells women to pursue certain forms of supplemental screening ahead of research evidence on what the exact benefits of the additional screening are and for which patients additional screening is most appropriate.

“Rather than requiring additional tests that may produce more false alarms, the emphasis should be on supporting trials of MRI and ultrasound to determine whether or not using them for screening average risk women can further reduce the death rate when added to mammography,” the ACR and SBI stated in their release.