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Currently 15 states have active legislation for expanded breast imaging insurance coverage (varying in scope). News! Insurance legislation in Connecticut and Georgia was signed into law this week:

1. Connecticut law (effective 1/1/2023), extends breast imaging coverage for women ages 35 and under if they are believed to be at increased risk.
2. Georgia law (effective 1/1/2023), covers diagnostic imaging, and supplemental breast imaging based on NCCN guidelines, with cost-sharing requirements “no less favorable than the cost-sharing requirements applicable to screening mammography.”

Learn more about individual State “inform” and insurance laws in our legislation MAP or TABLE.

#KnowBeforeYouGo

National Women’s Health Week kicks off on May 8th. To tie in and encourage mammography screening, DB-i will launch #KnowBeforeYouGo, a “mammogram and know-your-density reminder” social media campaign. Keep an eye on our Twitter and Facebook pages to participate by reposting and sharing these reminders.

About Our Education Coalition

DenseBreast-info is a non-profit public charity, and our mission is to provide guidance based on peer-reviewed clinical research. We do not accept advertising and all website content is manufacturer and modality “neutral.” We achieve our outreach with the assistance of unrestricted educational grants and donations, and DB-i is now the world’s leading website on the topic.

Our Education Coalition is Growing! We are pleased to welcome Myriad Genetics as a Corporate Supporter and Bayer AG as a European Supporter. We are grateful for the generous funding which assists in keeping this important tool viable and free.

Quiz #6 in the collaborative series with OBG Management magazine is now live. Each month’s quiz addresses a knowledge gap identified through the DB-i research study, Effect of an educational intervention on women’s healthcare provider knowledge gaps about breast density, breast cancer risk, and screening.  Please share these with women’s health providers in your network. 

1. Quiz #1, How is a woman determined to have dense breast tissue?
2. Quiz #2, True or false: Breast density increases breast cancer risk
3. Quiz #3, In which categories of breast density does tomosynthesis/3D mammography increase cancer detection over standard digital mammography?
4. Quiz #4, Average-risk women with dense breasts—What breast screening is appropriate?
5. Quiz #5, Your 28-year-old patient has a first-degree relative with a known disease-causing BRCA1 or BRCA2 mutation, but she herself has not been tested. Which breast screening method(s) should you recommend?
6. Quiz #6, What are the reasons to use the Gail risk assessment model?

European Radiology just published an editorial comment, Breast MRI for the “Masses” authored by our Chief Scientific Advisor Dr. Wendie Berg. Dr. Berg notes that the EUSOBI guideline stops short of recommending additional screening for the approximately 40% of women with heterogeneously dense breasts. The editorial further states that shared decision making “…requires both women and providers to be informed and for pertinent options to be available.”

DenseBreast-info.org/Europe:
To support evolving “dense breast” conversations in Europe, a DB-I European expansion was launched in 2018 featuring EU specific content and advisors. Our dedicated DB-I/European Team works tirelessly to promote website resources and education on the topic. Dr. Athina Vourtsis is a both a Medical Advisory Board member and our European Liaison, and Cheryl Cruwys is our European Education Coordinator. You can meet both at ECR!

Patient Questions and Answers:
NEW! Our Patient Question and Answer homepage has been redesigned to include a compelling animation of how a cancer might display on a mammogram in each of the 4 density categories. It now also provides quick access to the Top 5 questions/answers. This redesign is part of DB-I’s commitment to patient health literacy.

MAB Educators:
Join DB-I Drs. Wendie Berg and Athina Vourtsis for a free World Class CME webinar, Breast Density and the Need for Risk-stratified Screening Protocols, on April 20^th, 3pm ET (1 AMA PRA Category 1 Credit ™ / 1 Category A CE credit).

After striving for years for the rights of women to be equitably engaged in breast cancer awareness, knowledge, and communication, we are delighted to welcome EUSOBI recommendations on patient density “inform” and supplemental screening MRI for women with extremely dense breasts. DenseBreast-info.org and DB-i/Europe provide important educational resources to health professionals and women on the implications of breast density and effectiveness of supplemental screening in women with dense breasts. In a comment authored by Drs. Vourtsis and Berg behalf of DenseBreast-info.org, “A change in paradigm of breast cancer screening in European women with extremely dense breasts” (3rd letter in the linked page), the letter also highlights the potential benefits and need for supplemental screening for women with heterogeneously dense breasts.

Just out in the Journal of Breast Imaging: DB-I MAB members Drs. Jean Seely and Paula Gordon along with Drs. Peter Eby, Shushiela Appavoo and Martin Yaffe co-author “Errors in Conduct of the CNBSS Trials of Breast Cancer Screening Observed by Research Personnel.”  The Canadian trials were used as evidence to discredit screening women in their 40’s.

The startling conclusion:
“These firsthand accounts provide new information confirming that the CNBSS did not consistently and rigorously assess the true efficacy of screening mammography. The staff accounts clarify reasons why the CNBSS results were outliers compared with the six other randomized trials of screening mammography and should not be used as credible scientific evidence to inform health policy.”

Health literacy is the extent to which a person can receive, process, and understand health information to improve communication with their doctors and equip them to advocate for their own well-being. To evaluate DB-I patient materials, we have embarked on content review in conjunction with a health literacy expert. This will be a multi-month project, but we wanted to share some early updates to DB-I popular content:

1. Dense Breasts: 5 Facts You Should Know
2. New Question and Answer #18, “I have dense breasts and cancer might be missed on my mammogram. What else can I do?” which links to more extensive information on the same topic in Question and Answer #25, “What are other breast screening tests after my mammogram?”.

National Physicians Week:
Today begins National Physicians week in the U.S.  We recognize and thank DB-I’s stellar team of medical advisors and educators! Look for social media posts this week.

Erin Go Bragh!
In light of Covid-caused breast screening delays, DB-I has developed a series of “mammogram reminder” social media posts to encourage screening. Our playful St. Patrick’s Day post is attached.

Medical Advisory Board News
MAB member Dr. Regina Hooley’s recent Letter to the Editor, The Benefits of Early Breast Cancer Detection, was published in The New York Times (fourth letter in the linked page). She and co-author Dr. Susan Harvey weigh in on the “harms” of screening by highlighting the benefits of early detection and distinguishing between overdiagnosis and overtreatment.

Europe / Newly Published:
JUST OUT!  EUSOBI recommends EU women be “informed” of breast density and supplemental screening considerations: Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Some highlights:

• “Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened.”
• “In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years.”
  • “Where MRI is unavailable…ultrasound in combination with mammography may be used as an alternative.”

As a reminder, DB-I-Europe was developed to support such discussions and, among other resources, features educational tools for both European patients and doctors/health providers.

DB-I has a robust social media program to reach and share information with both patients and health providers. Please be an educational resource! DB-I’s educational posts (nearly daily) are intended to be shared. To “follow” us, please visit DB-I pages on Facebook, Facebook/Spanish, Twitter, LinkedIn and Instagram.

Did you know that March 1st is National Pancake Day in the U.S.?  DB-I had some light-hearted fun and participated on social media:

Newly Published:
New research just out in JAMA Network, Family History of Breast Cancer and Mammographic Breast Density in Premenopausal Women. The findings of this cohort study highlight “the heritable component of mammographic breast density and underscore the need to begin annual screening early in premenopausal women with a family history of breast cancer.”

 As a reminder, DB-I risk assessment educational tools include:

• Health provider resource Risk Model Tutorial
• Patient handout (printable)  Patient Risk Checklist (in Spanish here).

Just Published:
A promising article is just out in Best Practice & Research Clinical Obstetrics & Gynaecology, The Conundrum of Breast Density; Guidance for Healthcare Providers. The article emphasizes the lack of, and need for, consistent screening guidelines for women with dense breasts.

Summary: “The wealth of proxy data including worse outcomes of interval cancers, sensitivity of ultrasound in detecting cancers which tend to be smaller in size, possibly not requiring systemic chemotherapy, resulting in improved quality of life, should be considered by organizations making screening recommendations. Identifying women at higher risk of breast cancer and using these surrogate endpoints as criteria to endorse supplemental screening for selected women would allow consistent access to beneficial supplemental tests for selected high risk women.”

• The authors conclude,  “Explicit and consistent guidelines from our professional organizations would result in more streamlined provider education and consequently effective, consistent communication to our patients.”

DenseBreast-info’s own health provider educational resources to facilitate patient communication include:

• Free CME/CE course, Dense Breasts and Supplemental Screening
• In the absence of consistent U.S. screening guidelines,  DB-I Medical Advisory Board collaborative flowchart, Who Needs More Screening?
• Comprehensive list of FAQs
• To identify high risk patients, Provider Risk Model Tutorial
• Clinical resources:
  • Printable Patient Brochure (also available pre-printed, contact us for details)
  • Printable Patient Fact Sheet

The latest quiz in the collaborative series with OBG Management magazine is now live. Each month’s quiz addresses a knowledge gap identified through the DB-i research study, Effect of an educational intervention on women’s healthcare provider knowledge gaps about breast density, breast cancer risk, and screening.  Please share these within your referring provider network.

1. Quiz #1, How is a woman determined to have dense breast tissue?
2. Quiz #2, True or false: Breast density increases breast cancer risk
3. Quiz #3, In which categories of breast density does tomosynthesis/3D mammography increase cancer detection over standard digital mammography?
4. Quiz #4, Average-risk women with dense breasts—What breast screening is appropriate?
5. Quiz #5, Your 28-year-old patient has a first-degree relative with a known disease-causing BRCA1 or BRCA2 mutation, but she herself has not been tested. Which breast screening method(s) should you recommend?

 DB-i/Europe
Welcome! Prof. Mark F. McEntee, from the Republic of Ireland, has joined DB-i/Europe as a European Education Supporter. Our Education Supporters advance education on the implications of dense breast tissue and support DB-I/Europe content and resources.

Professor McEntee is Head of Medical Imaging and Radiation Therapy at University College Cork; mammography is among his varied research interests. He has published several popular papers on the measurement of breast density in digital mammography and digital breast tomosynthesis. His work has established Dose Reference Levels for Mammography in New South Wales and he has proposed new methods of calculating breast dose using the actual breast density of the patient rather than the mean glandular dose (MGD).

Patient Education Tools:
Our popular one-page downloadable Patient Fact Sheets are now available in 23 languages, the newest in Polish.  Many thanks to Wojciech Rudnicki, MD, PhD for translation assistance!

DB-I/Europe:
To better support patient education in Europe, a Patient Questions and Answers section has been added to the DB-I/Europe side of the website (within “European Patients” tab).

To provide dense breast information to women in the most understandable, useable, and actionable format, we have begun review of all patient content in conjunction with a health-literacy expert.  We have just launched the page Dense Breasts: 5 Facts You Should Know to serve as a quick introduction to the topic (please direct European patients to this link on the DB-I/Europe site).

Canada:
The Canadian Association of Radiologists Journal’s February Special Issue: Breast Imaging is available online. It was guest edited by DB-I medical advisory board member Dr. Jean Seely.