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Patient Equity, New Research, CSBI Position Statement

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Patient Equity: Density Inform and Insurance
Will 2023 be the year that both a national reporting standard and a federal insurance mandate for no-cost additional imaging become a reality in the U.S.? Just published in ITNonline, “Creating Patient Equity: A Breast Density Legislative Update.”

New Research
Just out in JAMA Network, Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening, which suggests that understanding of breast density’s contribution to breast cancer risk remains underappreciated by many women.

Canada
The Canadian Society of Breast Imaging has just issued a new Position Statement on Breast Arterial Calcification Reporting on Mammography. 

State Insurance Bill Introductions

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As mentioned, a U.S. federal bill for expanded breast imaging coverage, the Find It Early Act, has been introduced. While that legislation progresses on the federal level, 10 individual states have also introduced 2023 bills for expanded breast imaging insurance coverage. This is the beginning of most state legislative sessions, and more bills may be introduced.

The individual bills vary in scope of proposed coverage; please click on the link for actual bill content. Please note, a bill is often amended as it moves through the legislative process and bill language may not reflect the final language if signed into law.

Delaware          HB60
Hawaii               SB273
Missouri            HB575
                            HB147
Mississippi       SB2219
Nebraska          LB145
New Mexico     HB27
New Jersey       A4550
Pennsylvania*  SB1225
Virginia              SB1368
Washington     SB5396

*Pennsylvania’s bill carried over from the 2022 session

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
DB-i’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.”

Find It Early Act

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Federal legislation that would require insurers to cover no cost-sharing additional breast imaging for women with dense breasts or at higher risk for breast cancer, the “Find It Early Act”, was announced on Capitol Hill. This legislation should help address insurance barriers which contribute to the lack of health equity.

DB-i’s JoAnn Pushkin joined Reps. Rosa DeLauro and Brian Fitzpatrick and journalist Katie Couric to speak at the press conference. Creative credit goes to Dr. Wendie Berg for her suggestion that the DB-i tagline “Find it Early” be considered as the bill’s name.

While a bill number/link is pending, below is an excerpt from the bill:

COVERAGE WITH NO COST-SHARING FOR ADDITIONAL BREAST SCREENINGS FOR CERTAIN INDIVIDUALS AT GREATER RISK FOR BREAST CANCER

  • (A) With respect to an individual who is at increased risk of breast cancer (as determined in accordance with the most recent applicable American College of Radiology Appropriateness Criteria or the most recent applicable guidelines of the National Comprehensive Cancer Network) or with heterogeneously or extremely dense breast tissue (as defined by the Breast Imaging Reporting and Data System established by the American College of Radiology), screening and diagnostic imaging (with no limitation applied on frequency) for the detection of breast cancer, including 2D or 3D mammograms, breast ultrasounds, breast magnetic resonance imaging, or other technologies (as determined in accordance with such applicable criteria or guidelines); and
  • (B) with respect to an individual who is not described in subparagraph (A) and who is determined by a health care provider (in accordance with such most recent applicable criteria or guidelines) to require screening or diagnostic breast imaging by reason of factors, including age, race, ethnicity, or personal or family medical history, screening and diagnostic imaging (with no limitation applied on frequency) for the detection of breast cancer, including 2D or 3D  mammograms, breast ultrasounds, breast magnetic resonance imaging, or other technologies (as determined in accordance with such applicable criteria or guidelines).

New Patient Fact Sheet, RSNA Follow Up, Amazon Smile

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Patient Fact Sheets
The DB-i website features a full suite of patient education content including FAQs, videos and printable materials. Our very popular one-page downloadable Patient Fact Sheets are now available in over 25 languages, the most recent in Czech.

RSNA Follow Up /Medical Advisory Board

  • AuntMinnie.com Video from RSNA 2022: Contrast-enhanced Mammography interview with Dr. Wendie Berg details favorable results of contrast-enhanced mammography for breast cancer survivors across all density categories.
  • Educational paper, “2022 New Trends in Breast Density – What Should We Know?” (BREE 70-2022), co-authored by Dr. Flavia Sarquis was selected for inclusion in the October 2023 special issue of RadioGraphics.

Amazon Smile Program
DenseBreast-info.org is a 501(c)(3) non-profit public charity. We accept no advertising and are fueled by donations and unrestricted educational grants. Did you know you could shop and support us?

  • AmazonSmile can donate 0.5% of eligible purchases to DenseBreast-info when you shop at AmazonSmile, at no cost to you.
  • To get started, go to smile.amazon.com on your web browser (or activate AmazonSmile on your Amazon Shopping app on your iOS or Android phone, see “settings” on your app) and choose charity DenseBreast-info and then – SHOP!

RSNA Wrap Up

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The most often heard comment from RSNA attendees in Chicago this week was that though attendance was not quite what it was pre-Covid, the energy and crowds were “back.”  Some density-related highlights:

  • DB-i European Education Supporter and Past President of the ESR Prof. Michael Fuchsjäger received an Honorary Member Award as an Outstanding Educator in recognition of his significant achievements in radiology.
  • In a scientific session on Monday, Dr. Nicholas Payne of the University of Cambridge detailed research that mammography detects only 51.7% of cancers in extremely dense breasts, and only 50.6% of cancers in heterogeneously dense breasts in women under 60 – indicating the need for supplemental screening in younger women with heterogeneously dense breasts as well as those with extremely dense breasts.
  • A refresher course, Factors Influencing Breast Risk, Screening MRI, Screening US (S4-CBR10), given by Medical Advisory Board Members Drs. Berg, Harvey and Kuhl, emphasized the masking effect of cancers in dense breasts and the benefits of contrast-enhanced screening, especially in MRI, to find more biologically important cancers even in scattered density breasts.
  •  A HealthImaging.com article, Many providers remain underinformed about increased cancer risks associated with breast density, highlights two DB-i research projects published/in press in the JBI that were discussed in a talk by Executive Director JoAnn Pushkin. The research found that educational intervention can help.

RSNA prep, New Study

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RSNA
The 108th meeting of the Radiological Society of North America will take place November 27 – December 1. Educational opportunities from our Medical Advisory Board (MAB) members include:

  • Sunday 10:30 am, scientific session S2-SSBR01-2, Improving Surveillance of Women with Personal History of Breast Cancer Using Tomosynthesis or Contrast-Enhanced Mammography (TOCEM), room E450B, Dr. Wendie Berg
  • Sunday 1:00 pm, educational course S4-CBR10, Factors Influencing Breast Risk, Screening MRI, Screening US, room E450B, Drs. Jennifer Harvey, Christiane Kuhl, Wendie Berg
  • Education exhibit, poster 4522,  2022 New Trends in Breast Density – What Should We Know?, Learning Center BREE-7, Dr. Flavia Sarquis

New Study in Current Oncology
A prospective study, co-authored by MAB member Dr. Jean Seely, Feasibility Study and Clinical Impact of Incorporating Breast Tissue Density in High-Risk Breast Cancer Screening Assessment, assessed the feasibility and impact of incorporating breast tissue density (BTD) into the risk assessment of women referred to the High-Risk Ontario Breast Screening Program who were not genetic mutation carriers. Results showed that Incorporating BTD into risk assessment was feasible, did not increase the overall number of women eligible for B-MRI, and optimized supplemental B-MRI screening in women with dense breasts.

Provider Education

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Educating Providers in Related Disciplines
A concise presentation by Dr. Wendie Berg, Breast Density Notification Rule: 2022 FDA, just aired on Oncology Tube. Topics included the implications of dense tissue, details on supplemental screening options, and the upcoming FDA national reporting standard.

National Rad Tech Week
This week was National Rad Tech Week in the U.S.  DB-i highlighted the day by sharing a fan-favorite YouTube video of mammographer Cindy Staker discussing the importance of positioning and the role technologists play in cancer detection. if you haven’t seen this powerful short video, it’s worth the watch/share, here.

U.S. Federal Efforts for Insurance Coverage and Density “Inform”

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Federal Insurance Legislation
Congresswoman Rosa DeLauro (Connecticut) will soon introduce federal legislation that requires insurers to cover no-cost additional breast imaging for women with dense breasts or at higher risk for breast cancer. Given DB-i’s experience in bill analysis, Executive Director JoAnn Pushkin and Chief Scientific Advisor Dr. Wendie Berg were asked to review and offer input on bill language. We are particularly delighted that the DB-i tagline “Find it Early” is being used as the bill’s name!  More news on the introduction of the Find it Early Act will follow.

Federal Standardized Dense Breast Notification
The proposed insurance legislation complements the national “dense breast” reporting standard, also under development. As a reminder, the FDA is advancing a standard for breast density notification for American women and anticipates that this will happen by early 2023. Until that time, details on individual state inform laws are available here.

Latest Updates and News at DB-i

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Updated Table:
As new research is published, website content is reviewed to incorporate it. Newly updated is the popular Technology Tab table, Cancer Detection by Screening Method.

DB-i in the News:
Breast Cancer Awareness Month and news of an updated FDA timeline for a U.S. national “dense breast” reporting standard resulted in much demand for DB-i comments, story input, and images. Below are some national media opportunities we were included in:

FDA Density Notification on the Way?

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U.S. National “Dense Breast” Reporting Standard
U.S. Congresswoman Rosa DeLauro has announced that the FDA is advancing a standard for breast density notification for American women. The FDA anticipates that this will happen by early 2023. Read Rep. DeLauro’s press release HERE.

Patient Fact Sheets
Our popular Patient Fact Sheets are now available in 25 languages. Newly added are Chinese versions in Cantonese, Mandarin (Simplified), and Mandarin (Traditional). Our thanks go to Dr. Steven Cai and Ms. Nicky Li for translation assistance!

Update on Europe Meeting

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Wrap UP: EUSOBI 2022
The DenseBreast-info.org team would like to extend its thanks to the EUSOBI team for such a successful event with a wonderful scientific and social programme. “Dense breasts” was a hot topic! DB-i European Liaison, Dr. Athina Vourtsis and European Education Coordinator, Cheryl Cruwys reported on the increased level of discussion on the topic and extend a special thank you to all the DenseBreast-info.org/Europe Education Supporters for their warm support and reach out. Many thanks to MAB member Dr. Jiyon Lee for lending a hand with traffic (and photos) at our very busy table!

 

DB-i Voices in the News

Final #WorldDenseBreastDay Totals and Spanish Tools

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World Dense Breast Day (#WDBD):
Thank you for making history with us! The final stats are in and showed even a larger “turnout” for the event than initial analytics indicated:

  1. We had participation from people in over 37 countries
  2. Over 8.6 million people saw/read the posts
  3. Over 17,000 people interacted with the posts by clicking, liking, or sharing


U.S. Journalist and TV Personality Katie Couric
Katie Couric shared her personal story of breast cancer and dense breasts during our first annual #WorldDenseBreastDay. The non-stop social media activity for both #WDBD posts and her story make clear the strong interest and need for accurate information on the topic. Enjoy this piece about Katie Couric ‘s experience which includes DenseBreast-info.org and links to our U.S. legislation map: https://www.today.com/health/what-are-dense-breasts-fda-wants-women-know-about-breast-t151225?cid=sm_npd_td_tw_ma


Breast Cancer Awareness Month, Spanish Tools:
A reminder that DB-i dense breast education tools are available in multiple languages including a full suite of patient content in Spanish. Spanish-language tools include:

World Dense Breast Day, SUCCESS!

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DB-i launched the first ever #WorldDenseBreastDay on Sept 28th. Nearly 100 posts with great images were created and ran for 24 hours across our social media channels. Though still compiling analytics, we want to extend our gratitude to groups and health systems from across globe for participating in this 24-hour educational event and making history with us. Some early insights indicate:

  • We had participation from people in 37 countries
  • Over 8.6 million people saw/read the posts
  • Over 17,000 people interacted with the posts by clicking, liking, or sharing

World Dense Breast Day!

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On September 28th, we are honored to host the inaugural World Dense Breast Day event to promote education about dense breasts.

Sponsored by DenseBreast-info.org, the day has been added to the National Day Calendar. The purpose of this worldwide 24-hour social media blitz is to raise awareness about dense breasts and share medically sourced educational resources.

For more details about the day:

How you can participate:

Join us in making history as we launch this one-day worldwide education event!

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