Jennifer Bergin, MD; Alicia Arnold, MD
Wisconsin’s new Breast Density Notification Law, 2017 Wisconsin Act 201 (Assembly Bill 653), requires facilities that perform mammograms to notify women categorized as having heterogeneously dense or extremely dense breast tissue (BI-RADS density categories C and D) about their condition.
Signed in April, the law makes Wisconsin the 35th state to pass breast density legislation. Representative Mike Rohrkaste authored the bill at the request of a constituent who was diagnosed with advanced breast cancer after dense tissue masked the tumor on her mammogram.
Facilities that perform mammograms are now required to include language that is substantially similar to the following sample language in, or along with, their required patient results letters:
Your mammogram shows that your breast tissue is dense. Dense breast tissue is found in almost 40 percent of women and is a normal finding. However, studies show that dense breast tissue can make it harder to find cancer on a mammogram and is associated with a slightly increased risk of breast cancer. Regular screening mammograms are still recommended for you. This information is provided to raise your awareness about the result of your mammogram. You can use this information to talk with your health care professional about your own risks for breast cancer. Together, you can decide which screening options are right for you. The results of your mammogram were sent to your doctor. Please note that breast density is affected by several factors and may change over time.
Patients who receive these notices most likely will seek guidance and ask questions, eg, whether any supplemental screening is recommended. There is currently insufficient evidence to support the routine use of additional screening tests beyond mammography in women whose only risk factor is dense breast tissue. However, for patients who have dense breast tissue, it may be useful to conduct a risk assessment to determine if additional screening is recommended. Many health systems’ electronic medical records have a built-in assessment tool, or there are several online screening tools, including the following:
- Tyrer-Cuzick model, version 8 (includes breast density)
- Bright Pink
- Gail risk model
To further assist clinicians and their patients, the Wisconsin Radiological Society, with support from the Wisconsin Medical Society, has developed a set of FAQs and compiled a number of resources. One particularly useful tool for physicians may be clinical scenarios, which address a variety of patient situations and the recommended actions in flow chart format.
- Clinical Scenarios
- Frequently Asked Questions
- American College of Radiology position Statement on Breast Density
- American College of Radiology Position Statement on Higher-risk Women
- Supplemental Screening for Breast Cancer in Women with Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force
While these resources are hopefully useful in assisting clinicians and patients in understanding the new law and notifications, each situation is unique and will require assessment as well as individual patient and physician discussion to determine the correct course of action.