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State insurance bills, Order of Ontario

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State Insurance Bills
The 2025 legislative session has begun and new insurance bills to cover expanded breast imaging have been introduced in the following states:


Congratulations!
MAB member Dr. Jean Seely has been awarded the Order of Ontario, the province’s highest civilian honor. She was recognized for excellence in breast imaging, and her work has changed clinical practice guidelines for mammography in Canada. Her clinical research has resulted in landmark studies that have led to a better understanding of how mammography screening beginning at age 40 impacts both morbidity and mortality.

MAB News, Happy Holidays!

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Congratulations! Dr. Paula Gordon has been officially invested in the Order of Canada! It is one of the country’s most prestigious honors and recognizes citizens who have made extraordinary contributions to the nation. Dr Gordon has been an effective and relentless advocate for patient notification of breast density as well as appropriate screening beyond mammography.

We wish everyone a Happy Holiday and Happy New Year!

Updates from RSNA

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SBI Announcements
Congratulations to DBI’s MAB member Dr Paula Gordon for the SBI Gold Medal recognition for her outstanding contributions to breast imaging, and to JoAnn Pushkin for being named 2025 SBI Honorary Fellow!

Abstracts
Prevalence screening results from the randomized UK BRAID trial were presented by Dr. Fiona Gilbert at RSNA 2024.  More than 9000 women with dense breasts and negative 2D mammogram aged 50-70 years were randomized to one of four screening groups (over 2000 women in each group): supplemental screening with abbreviated MRI (Ab-MRI), automated whole breast ultrasound (ABUS), contrast-enhanced mammography (CEM), or standard of care (no supplemental screening).

  • Cancer detection rates and recall rates were higher for CEM and Ab-MRI than ABUS, but all modalities significantly increased cancer detection1
  • Among those women invited to supplemental screening, participation rates were highest among women invited to have ABUS2
  • All cancers detected were small, but cancers seen with contrast methods were smaller3
  • All cancers detected by ABUS were invasive, as were 82% and 86% detected by CEM and Ab-MRI, respectively

 Supplemental screening in women with dense breasts results in earlier detection, with Ab-MRI and CEM finding more cancers than ABUS with higher recall rates.

 1 Cancer detection rates and recall rates for Ab-MRI, ABUS, and CEM were 17.4/1000, 4.2/1000, and 19.2/1000, respectively and 9.7%, 4.0%, and 9.7%, respectively.

2 Approximately 95.5% of invited women completed ABUS vs. 91.8% Ab-MRI and 91.1% CEM.

3 Median invasive cancer size for Ab-MRI, ABUS, and CEM respectively was 10 mm (IQR: 8-15 mm), 22 mm (IQR: 14 – 35 mm) and 11 mm (7 – 15 mm).

 Results of another study presented at RSNA 2024 by Annie Ng, Ph.D., from Kheiron Medical Technologies (now Deep Health), London, UK, found that a 2D-mammographic AI system identified more cancers than a human reader in dense breasts. The retrospective study compared sensitivity of the commercially available Mia AI system to the first human reader in double reading among 306,839 cases from over 236,739 women between 2017-2021. 

  • Sensitivity of AI was significantly greater than the human reader in women with dense breasts, whereas there was no statistical difference among women with non-dense breasts1
  • These results were maintained when analyzed by age in women aged 49-55 years or 56-71 years, respectively

 AI as a second reader has the potential to increase cancer detection in women with dense breasts compared to human readers alone.

Mammo Screening Guideline Comparison Table, Silver Medal of Honor, New Studies

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Comparison In Average Risk Women
This popular DBI table just updated to include the new ACOG recommendation that mammograms begin at age 40. Visit the table for comparative mammography recommendations by organization on recommended age to start, stop, and frequency.

Congratulations!
On October 24, 2024, Dr. Wendie Berg, Chief Scientific Advisor to DenseBreast-info.org, received the prestigious Silver Medal of Honor from the Austrian Medical Society to recognize her contributions to the design of the Austrian Breast Cancer Screening Program (which includes screening ultrasound for women with dense breasts).

New Studies:

-Breast Density and Sensitivity of Digital Mammography
Consistent with many prior analyses, Payne et al reported in a single-center UK study that digital mammography sensitivity decreases with increasing breast density as assessed by Volpara software, at 75% for grade a, 74% for grade b, 60% for grade c, and 51% for grade d.  Symptomatic interval cancer rates at three years increased from 1.8 per 1000 for grade a to 3.2, 5.7, and 7.9 per 1000 for density grades b, c, and d, respectively.

-CEM for Breast Screening
A retrospective, single-institution study by Sorin et al. from Tel-Aviv University evaluated performance of CEM for breast cancer screening over a 10-year period in 5,424 women at intermediate or high risk for breast cancer (15-20% lifetime risk and >20% lifetime risk, respectively), with the following results:

  • Most women (85%) included had dense breasts
  • Contrast enhancement increased cancer detection compared to the low-energy images (which are similar to a standard 2D mammogram)1,2
  • Specificity for CEM increased from the first to the third screening round, likely due to familiarity with the modality and availability of prior exams for comparison3

This study supports the viability of CEM as an effective screening modality for women with dense breasts and/or at intermediate breast cancer risk, and for high-risk women for whom MRI is not possible.

1Sensitivity for contrast-enhanced CEM images was 96% (71/74) compared to 58% (43/74) for low-energy images alone.  

2The added cancer detection rate for CEM compared to the low energy images was 5.2 per 1000 screens (13.1/1000 for CEM vs. 7.9/1000 for the low energy images).

3Specificity overall was 81.8% (4378/5350); patient-level analysis showed improvement from 79.2% (2717/3431) in the first round to 89.2% (412/462) in subsequent rounds.

Canada Inform, ILC Imaging, Research Grant

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Density Inform / Canada
Good news from DenseBreastsCanada! Dense breast notification from coast to coast goes into effect this summer in Canada! Well done to advocates Jennie Dale and MAB member Dr. Paula Gordon for their tireless efforts.

JBI Article on Imaging for ILC
In an article co-authored by MAB members Drs. Wendie Berg and Lars Grimm, the majority of SBI member radiologists surveyed felt that additional screening beyond mammography was needed to detect ILC in dense breasts, to image extent, and in women of all breast densities with treated ILC.

New Research Grant
Congratulations to Dr. Wendie Berg on the award of a research grant from the PA Breast Cancer Coalition as co-PI with Dr. Shandong Wu to study the use of AI added to contrast-enhanced mammography to reduce false positives in screening!

Get Ready for RSNA

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DBI presentation:

Tuesday, 11am: Vendor workshop, join DBI’s Director of Education and Epidemiology Research, Robin Seitzman, PhD, MPH, for her talk, Implementing the National Dense Breast Reporting Standard. Details: 11:00 a.m. – 11:30 a.m.| IT1-VW101 | Booth #8349 |GE Healthcare Ultrasound and Breast Care Solutions Education room

 

MAB activities:

Exhibit Hall: Dr. Linda Larsen, et al., Comparison of indications, reading time, and workflow of FDA approved supplemental screening automated whole breast ultrasound tomography in women with dense breasts. BREE-8

Sunday

  • 12pm: Vendor workshop, Dr. Athina Vourtsis will be presenting, A successful ABUS program with review of latest clinical evidence for supplemental screening for women with dense breasts. Details: noon | GE HealthCare | IS1-VW101 | Booth 8349, North Hall, Level 3
  • 1pm: Join Dr Lars Grimm for his talk,Reducing Overtreatment in Early Stage Breast Cancer: Insights from Radiology. Details: 1pm-2pm | S4-CBR03 | S406A
  • 2:40pm / Scientific Paper from DBI’s Dr Wendie Berg, Robin Seitzman, PhD, MPH, et al., Factors Influencing False Positive Recall Rates on Contrast-Enhanced Mammography (CEM). Details: 2:40pm | E4508

Monday

  • 8:10am: Past DBI Medical Advisory Board member Carrie Hruska, PhD, will present Molecular breast imaging and DBT: Better together. Details: 8:10 a.m.-8:20 a.m. | M1-SSBR03-3 | E352
  • 8:40am / Scientific Paper from Dr Wendie Berg, et al.:Screening Contrast-Enhanced Mammography as an Alternative to MRI (SCEMAM). Details: 8:40 am | E351
  • 9:30am: Dr. Jean Seely will present, Multimodality Challenging Breast Cases. Details: 9:30am | M3-CBR04 | S406A
  • 12:45pm: Dr. Laurie Margolies, The Tyrer-Cuzick Risk Model: Is it Effective for All Races?. Details: 12:45pm | M5B-SPBR-5 | CST Learning Center
  • 1:30pm: Dr. Toula Destounis, BI-RADS 6th Edition Update. Details: 1:30pm | M6-CBR05 | S406A

Tuesday

  • 9am: Hands-onLab, Breast US Biopsy, join Dr. Toula Destounis (Director) and Drs. Paula Gordon, Regina Hooley, Georgia Spears, Laurie Margolies, and Athina Vourtsis. Details: 9am | T2-CBR15 | S504CD
  • 9:00am: Scientific Poster Session, Drs. Stu Kaplan, Linda Larsen, Comparison of quantitative volumetric and subjective BI-RADS density classification in women with dense breasts. Details: 9am | T2-SPBR-2 | Learning Center
  • 3pm: Dr. Toula Destounis, Oral presentation: Update on Management of Patients Diagnosed with Lobular Carcinoma in situ at Needle Core Biopsy in an Outpatient Breast Imaging Center: A 20 Year Review.Details: 3 pm | T7-SSBR06 | S404  

Wednesday

  • 12:15pm: Scientific Poster Session, Dr. Toula Destounis, Outcomes of Supplemental Breast MRI in a High Risk Screening Program. Details: 12:15pm|W5A-SPBR | Learning Center
  • 1:30pm: Refresher Course/ Breast Screening and Breast Cancer Risk.  Dr Wendie Berg on Breast Screening with US: Should We Do It?; Dr. Emily Conant on Factors Influencing Breast Cancer Risk on Imaging; Dr. Chris Comstock on Breast Screening with MRI.  Details: 1:30-2:30 pm | S406A
  • 4:30pm: Dr. Athina Vourtsis presents in session Multimodality Challenging Breast Cases. Details: 4:40pm | W8-CBR11 | S406A

Thursday

  • 9am: Dr. Laurie Margolies, Evaluating Mammography Positioning Quality on Digital Screening Mammograms in Large Urban Health Systems – Same as Film? Details: 9am | R2-SPBR-7 | Learning Center
  • 9:30am: Dr. Laurie Margolies in session, Localization and Biopsy Techniques for the Breast. Details: 9:30am | N229 |R3-CBR12
  • 11am: Dr Paula Gordon on breast screening in Canada, Breast Screening Update. Details: 11am |R4-CBR13 E450B

DBI Spanish Language Materials & Support

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News! The DBI Spanish language site SenosDensos.org is updated and more accessible. There has been a substantial increase in visits to DBI’s Spanish content and we are ready to address these educational needs!

In recognition of his long-term commitment to DBI Spanish language content development and expansion, we are delighted to announce that MAB member Dr. Daniel Lehrer, Breast Imaging Specialist and Medical Director at CERIM in Argentina, is now DBI Spanish Language Advisor. His tireless work assures that DBI content is, and will be, available to Spanish speaking women all over the world.

Research and MAB News

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New Research
Finding it early saves lives and money. New research out in Current Oncology, Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing details that “…the cost of BC treatment is many orders of magnitude less when BC is diagnosed at an earlier stage, and that costs increase exponentially with stage. The magnitude of difference in cost for treatment of late-stage compared to early-stage BC has been previously noted to be 3–4 times; however, our study shows a cost differential of up to 36 times in magnitude when DCIS is compared with stage IV.”

Welcome!
DBI welcomes new Medical Advisory Board members Dr. Sheila Appavoo and Dr. Lars Grimm and welcomes back Dr. Jennifer Harvey! Our hardworking volunteer MAB members contribute to and review all website content.

DENSE Trial 

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A study of women with extremely dense breasts, the Dutch DENSE trial, has shown that adding MRI to mammography every two years improves cancer detection and reduces interval cancer rates. In a secondary analysis published in Radiology, women in the top third of enhancing volume of breast tissue on MRI were twice as likely to develop breast cancer as those in the lowest third. As incoming DBI MAB member Dr. Lars Grimm points out in an accompanying editorial, it is important to consider combinations of breast density and other risk factors that qualify women as “high risk” and therefore eligible for continued screening MRI under current guidelines.

Nebraska insurance law, Just published

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State Insurance Law
Legislation for expanded breast imaging insurance coverage has been signed into law in Nebraska. Please see DBI’s Legislative Info for updated map and table details.

Just Published
In Cancer, coauthored by DBI MAB member Dr Sally Herschorn, Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.  Many women at high risk of screening mammography failure do not currently undergo supplemental screening beyond mammography.  Health care provider and patient awareness of other breast cancer risk factors beyond breast density, including family history and prior benign biopsies, is important in identification of women at high risk of mammography screening failure (interval cancer or advanced breast cancer) who should be recommended for supplemental screening with ultrasound or especially MRI. It is important to recognize that limiting supplemental screening to women at intermediate- to high-risk by the BCSC model would fail to identify 30-40% of women with dense breasts who will experience interval cancer and about 60% of all women who will develop advanced breast cancer.

New Research

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Just published in Journal of Clinical Oncology, a case-cohort study, Long-Term Performance of an Image-Based Short-Term Risk Model for Breast Cancer. Conducted at Karolinska Institutet, the study showed an image-based risk model developed to predict short-term breast cancer risk can also be used to assess long-term risk for identifying women who may benefit from risk-reducing strategies and supplemental screening. The image-based model showed better accuracy in predicting 10-year risk than the Tyrer-Cuzick v8 model, a traditional lifestyle/familial-based risk model.

New Research

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Topic: Tech Performed Handheld Ultrasound After 3D
Just published in the Journal of Clinical Oncology, authored by Dr. Wendie Berg, and coauthored by Dr. Marcela Böhm-Vélez and others, Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound after Tomosynthesis in Women with Dense Breasts (the DBTUST).

  • The prospective multicenter study of technologist-performed handheld ultrasound screening after 3D mammography showed a modest added cancer detection rate from ultrasound of about 1 cancer per thousand screens each year for three years and 4% added false positive rate. Many cancers missed initially were visible on targeted ultrasound, and other studies using automated ultrasound or physician-performed ultrasound, and studies in Asia and Canada have shown higher added cancer detection rates from ultrasound. Contrast-enhanced approaches such as MRI or CEM are expected to produce far greater cancer detection. Many women cannot tolerate or access contrast-enhanced approaches and ultrasound is then a good option.

Topic: Knowledge Gaps About Breast Cancer Risk Model Use/High-risk Screening
DBI’s third research project just out in the Journal of Breast Imaging, Effect of an Educational Intervention on Women’s Health Care Provider Knowledge Gaps About Breast Cancer Risk Model Use and High-risk Screening Recommendations.

  • The research shows that important knowledge gaps regarding appropriate use of the Gail model versus the Tyrer-Cuzick model exist, and providers were unclear about what types of imaging to recommend for screening women at high risk of breast cancer. Nearly all knowledge gaps significantly reduced after web-based education based on DenseBreast-info.org content and reviewed in our CME course, Dense Breasts and Supplemental Screening.

Update: Find It Early Act

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The Find It Early Act, a federal bill for or expanded insurance coverage for no-cost screening and diagnostic imaging for women with dense breasts or at increased risk, can be accessed HERE. Please save and check this page for bill updates.

MAB Member Honored
Congratulations are in order! Dr. Paula Gordon has been appointed to the Order of Canada which honors citizens who make extraordinary contributions to the nation. Dr. Gordon was specifically recognized for “advancing ultrasound imaging and technology in the early detection of breast cancer, as a prominent radiologist and researcher.”

National Comprehensive Cancer Network (NCCN) News & More

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Patient health literacy is in the air! Following the news of DB-i’s health literacy review of website patient content, the NCCN has published new patient guidelines in patient-friendly plain language. The new guidelines were developed to help patients ask the right questions about when and how often to screen for breast cancer. The guidelines emphasize annual mammograms for all average-risk women over 40. Please visit the NCCN’s 2022 Breast Cancer Screening and Diagnosis guidelines to learn more.

Recently Published
A research article co-authored by DB-i Medical Advisory Board member Dr. Jean Seely was published in BMC Cancer, Randomized trial of surveillance with abbreviated MRI in women with a personal history of breast cancer– impact on patient anxiety and cancer detection. The study aimed to determine if surveillance mammography plus abbreviated MRI reduced psychological distress and if abbreviated MRI improved cancer detection rates as compared to mammography alone.

Educational Needs for European Providers and News Out of Canada

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Educational Needs of Referring Physicians

In the current issue of Radiology Today, our OB/GYN Medical Advisory Board members, Drs. Elizabeth Etkin-Kramer and DaCarla M. Albright, share their insights on the educational needs of referring providers, Women’s Imaging – Educational Needs of Referring Physicians in Managing Patients with Dense Breasts. Included is a Case Study in Education by Dr. Toula Destounis that details how her center addressed referring provider and community education when New York’s density inform law went into effect.

Canadian MAB Member News:

Congratulations to Dr. Paula Gordon, 2020 recipient of the Prix d’excellence – Specialist of the Year! Dr. Gordon, a tireless and engaged voice on the topic, is a medical advisor to both DenseBreast-info.org and patient advocacy effort DenseBreastsCanada.ca

New MAB Spotlight:  Dr. Jean Seely is Professor of Medicine in the Department of Radiology at the University of Ottawa. She is Head of the Breast Imaging Section at the Ottawa Hospital, Regional Breast Imaging Lead for the Ontario Breast Screening Program in Champlain region and Co-Chair of the Canadian Association of Radiologists’ Breast Imaging Working group and sits on the Executive board of CAR Mammography Accreditation Program. She is a Fellow of the Society of Breast Imaging. She is an Editorial Board member of Canadian Association of Radiology and Breast Imaging Journals. Her commitment is to reduce the mortality and morbidity of breast cancer and provide high quality breast imaging nationally and internationally. She is President of the Canadian Society of Breast Imaging. Her research interests include Breast MRI, breast cancer screening, quality in breast imaging and patient experience. We are delighted to have Dr. Seely on board!

OBGYN Reach Out

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Referring Provider Reach Out

Patient breast cancer screening discussions typically rest on the shoulders of ObGyns. How can ObGyns and radiologists collaborate on patient screening? What are patient discussion topics and what resources are available? Please see insight in the OBG Management magazine article, How ObGyns Can Best Work with Radiologists to Optimize Screening for Patients with Dense Breasts, authored by our ObGyn MAB members Drs. Etkin-Kramer and Albright and Executive Director JoAnn Pushkin.

DenseBreastDay™
Our third annual #DenseBreastDay™ was another social media success! A round-up of the day’s activities and highlights are available HERE. Look for an expanded international effort in 2021!

Reminder: Free Access for October
A review article by Dr. Wendie Berg, Chief Scientific Advisor to DB-i, and co-authors has just been published in AJR. It is an up-to-the-minute review of realistic screening options for women with dense breasts. The review includes a comparison of cancer detection rates, recall rates, and barriers to implementation of tomosynthesis, screening ultrasound, molecular breast imaging, MRI, and contrast-enhanced mammography in women with dense breasts:  Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review.

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