Purpose: Breast Density Notification laws, passed in 15 states as of April 2014, mandate that breast density information be given to patients often without guidance on modalities, patient selection or funding for supplemental screening. The purpose of this study is to assess the impact of breast density notification laws on radiology practices, specifically regarding breast cancer risk assessment and supplemental screening studies.
We performed an anonymous 20-question web-based survey to Society of Breast Imaging radiologists using a Qualtrics Survey Tool between 8/2013-3/2014, with questions on radiology practices, breast cancer risk assessment, breast density measurement, supplemental screening tests, and support for referring physicians and patients. We compared survey results between groups using Fisher’s exact test.
121 radiologists from 110 facilities (48 academic, 43 large private hospital, 15 small private hospital and 4 other) representing 34 USA states and 1 Canadian site responded. 49% of facilities (54/110) were in states with an enacted breast density notification law. 37% of facilities (40/109) performed risk assessment, 26% (28/109) did not perform risk assessment, and 38% (41/109) did not but reported family history/other risk factors, with no significant difference in performing risk assessment between facilities with or without an enacted law (p-value 0.71). Of the 37 facilities performing risk assessment, 60% used the Gail model, 22% used the Tyrer-Cuzick model and 11% used the modified Gail model (multiple answers allowed [m.a.a.]). Of the 15 facilities performing risk assessment, 40% answered "yes" when asked whether performing risk assessment is a new task because of the density law. Breast density was estimated by only visual assessment in 98% of facilities (103/105), and by computer-based determination with or without visual assessment in 2% (2/105). Supplemental screening studies offered included magnetic resonance imaging (MRI) (88%, 92/105), handheld whole breast ultrasound (HHWBUS) (48%, 50/105), tomosynthesis (39%, 41/105), and automated WBUS (8%, 8/105) (m.a.a.). There was no significant difference in supplemental screening studies offered between facilities with or without an enacted law (p-value 0.26). In anticipation of the law, facilities implemented HHWBUS (33%, 16/48), tomosynthesis (6%, 3/48), automated WBUS (6%, 3/48) or none (60%, 29/48) (m.a.a.). Facilities with the enacted law prepared for the law with referring physician discussions (69%, 34/49), website (49%, 24/49), educational talks for referring physicians (43%, 21/49) or patients (31%, 15/49) (m.a.a.).
Our survey showed variations in available supplemental screening modalities and policy implementation at each facility. There was no significant difference in performing risk assessment and supplemental screening studies between facilities with or without an enacted breast density notification law.
Citation Format: Lina Nayak, Kanae K Miyake, Yueyi Irene Liu, William R Thomas, Edward A Sickles, Bonnie N Joe, Karen Lindfors, R J Brenner, Stephen Feig, Lawrence W Bassett, Jessica W Leung, Haydee Ojeda-Fournier, Jonathan Hargreaves, Elissa Price, Jafi A Lipson, Allison W Kurian, Elyse Love, Donna D Walgenbach, Lauren Ryan, Meg Durbin, Bruce L Daniel, Linda Garcia, Debra M Ikeda. Impact of breast density notification laws on radiology practices: A survey of 110 radiology facilities [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-02-02.