What are “dense breast laws?”

Women in many states have complained to their legislators that they developed malignant lumps in their breasts that either they or their health care provider found shortly after a mammogram and after receiving a letter from their radiologist assuring them that their mammogram was normal.  No mention was made that because they had dense breasts they could not be given complete assurance that their breasts were cancer free. In response to this problem, the legislatures in five states, including the three largest states, California, Texas and New York, have passed laws that the radiologist must inform women who have dense breasts and a normal mammogram that there are other tests such as ultrasound and MRI that can find cancers that are missed by the mammogram in these women with dense breasts.

The law in California passed at the end of August, but does not go into effect until April 1.  If you live in this state and you have dense breasts, by law the paragraph below will appear in the mandated letter that you receive after your mammogram:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”

It is true that dense breasts inherently have a small increased risk of developing breast cancer compared with fatty breasts.  What this warning does not say is that the chance of the mammogram missing a small curable cancer is significantly greater with dense breasts than with fatty breasts.  Addition of a second test such as ultrasound or MRI to the mammogram in women with dense breasts should reduce the chances of a cancer not being seen to about the same as for women with fatty breasts by mammography alone.

Although, generally speaking, these additional tests are not covered by insurance, it is the women’s right to know that these tests are available, and usually will find cancers earlier and smaller when added to the mammogram, compared with the mammogram alone.

 

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