As Massachusetts joins the ranks of states weighing legislation requiring mammography patients to be informed if they have dense breast tissue, the state also is streamlining the process by requiring imaging facilities—not physicians—to communicate information about breast density to patients at the completion of a mammogram.
The question implicit in that arrangement is whether the proposed new law would place an undue burden on professional staff to transmit breast density information. The Massachusetts bill (S.1006) says specifically that any mammography facility licensed by the Massachusetts Department of Public Health must provide patients with a notice about breast density at the completion of their mammogram.
David E. March, M.D., is the Medical Director of Breast Imaging at Baystate Breast & Wellness Center in South Hadley, Mass., and he doesn’t see a problem with centers playing the role of messenger.
“It makes sense for the centers that perform mammography to notify patients about density,” March told Imagingbiz in an e-mail. “Radiologists routinely include information about tissue density in their mammography reports.
“Complying with the new law would be straightforward,” he wrote. “We are already required by the FDA to send all mammography patients a letter describing the results of the study in lay terms. We could easily update these letters to include information about the patient's tissue density.”
About 40 percent of women have dense breast tissue, March wrote, which is not only associated with a greater incidence of breast cancer risk, but also makes harder to detect potential problems through traditional mammography.
As such, patient notification isn’t only a necessary component of improving care, but it could also emphasize the limitations of mammography in uncovering potential risks.
“Some of these women may want to consider screening with other modalities, especially if they are at high risk, and may want to discuss these options with their physicians,” March wrote.
“Education about the strengths and limitations of the different options will be important, including the possibility of false-positive (noncancerous) findings that may lead to additional follow-up imaging or biopsy.”
Additional screening procedures and tests could bring in more business for imaging centers and physicians, but March also cautions that accommodating those extra patients “and managing the findings detected on these exams” could also mean increased costs and longer hours for professional staff.