USPSTF Guideline Fails to Address Dense Breasts, more HERE. 

 

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U.S. State Insurance Laws & Canada News

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U.S. State Insurance Laws
New state insurance laws for expanded and/or no-cost breast imaging have been signed into law in Arizona, Montana, New Mexico, Pennsylvania, Tennessee, and Washington. Please see DBI’s Legislative Info tab for details. Missouri’s bill is on the governor’s desk for consideration and may be next.

Canada
Just Published
British Columbia Medical Journal, article Breast cancer screening in BC: What we should be proud of and how to make it even better, by DBI Medical Advisory Board member Dr. Paula Gordon.

CAMRT Course Listing
DBI’s CME/CE course Dense Breasts and Supplemental Screening is now available through the Canadian Association of Medical Radiation Technologists (CAMRT) Repository, HERE.

Credit information reminder:

  • The CAMRT and the Medical Radiation Practice Board of Australia accept Category A continuing education credits to be used toward continuing professional development requirements by medical radiation technologists and medical radiation practitioners.
  • The UEMS-EACCME® has mutual recognition agreements with the AMA for e-learning materials. Additionally, the Royal College of Physicians and Surgeons of Canada accepts AMA PRA Category 1 credits earned through self-learning activities to be used for Continuing Professional Development Section 2 credits.

USPSTF, ACR Recommendations, U.S. Insurance Legislation

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United States Preventive Services Task Force (USPSTF)
USPSTF updated screening guidelines updates were just published and now include the recommendation that mammography screening in normal risk women occur every other year beginning at 40 (was 50).  Unfortunately, for women with dense breasts, the recommendations incorrectly conclude there is “inadequate” evidence to support adding supplemental screening ultrasound or MRI after a mammogram and fail to recognize the important of annual screening.

2023 ACR Screening Recommendations for Women at Higher Risk
New recommendations just published! For women at higher-than-average risk of breast cancer, the ACR recommends annual digital mammography, beginning between ages 25 and 40, and supplemental screening, depending on risk, with breast MRI as the supplemental method of choice. Notably, women with extremely dense breasts are considered to have approximately twice the “average” risk, and for women with dense breasts who desire supplemental screening, breast MRI is recommended.

Federal Bill, the Find It Early Act
The federal insurance bill, the Find It Early Act, has been re-introduced in this session of Congress by Reps. DeLauro and Fitzpatrick. Their announcement HERE.

New U.S. State Insurance Laws
Insurance coverage for breast imaging has been signed into law in:

  • Pennsylvania (Act 1 of 2023). The law provides for “all costs associated with one supplemental breast screening every year if a woman is believed to be at an increased risk of breast cancer” due to specified reasons. The law also provides coverage for BRCA-related genetic counseling and genetic testing.
  • Maryland (Chapter 0298). The law prohibits, “… except under certain circumstances, insurers, nonprofit health service plans, and health maintenance organizations that provide coverage for diagnostic and supplemental breast examinations from imposing a copayment, coinsurance, or deductible requirement for the examination.”

For more details, please visit the DBI Legislative Information tab.

Journal of Breast Imaging

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An article is just out in JBI  “Implementing the National Dense Breast Reporting Standard, Expanding Supplemental Screening Using Current Guidelines, and the Proposed Find It Early Act” authored by DBI’s Dr. Wendie Berg, Dr. Robin Seitzman, and JoAnn Pushkin. One of the conclusions is, “With a new national standard for density notification, breast imaging radiologists and centers should be preparing. Development of a protocol for evaluating the need for, and recommendation of, supplemental screening, and ways to facilitate orders from their referring physician community are opportunities.”

Upcoming Symposium and More

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2023 SBI Breast Imaging Symposium
DBI’s Dr. Wendie Berg, Robin Seitzman, PhD, MPH, and JoAnn Pushkin will be in attendance.  Please stop by booth #326 to learn more about DBI educational tools or to discuss the FDA dense breast reporting rule or the federal Find it Early Act.

Media
The announcement and implications of the new FDA “dense breast” reporting rule continue to attract much press interest:

 Europe  

  • Dr Wendie Berg discusses improving early detection of breast cancer by implementing current guidelines and technologies with EUSOBI’s Prof. Matthias Dietzel in a YouTube video available HERE.

Website Update

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As new research is published, the DBI website content is reviewed and edited, including:

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.

2D vs 3D Mammography and More

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New Research
DBI Medical Advisory Board member Dr. Emily Conant is lead author on Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings. The findings indicate that women undergoing digital breast tomosynthesis had higher cancer detection rates, higher positive predictive value, and lower recall rates compared with women who underwent digital mammography. Consistent with other studies, the study found improved cancer detection rates for women with heterogeneously or extremely dense breasts using 3D.  Recall rates were reduced in heterogeneously dense breasts but not in extremely dense.

Europe
DBI’s European Education Coordinator Cheryl Cruwys has been active educating on the implications of dense tissue and sharing DenseBreast-info.org/Europe resources:

FDA National Reporting Standard

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At long last, the U.S. Food and Drug Administration (FDA) has announced updates to mammography regulations to notify women and their referring providers about a woman’s breast density. States will have until Sept 10, 2024 to comply and once the rule goes into effect one of the two (not dense or dense) federal density notification statements will be required in all patient letters. More HERE.

DBI Content Updates

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Patient Content
Our popular “Dense Breasts, 5 Facts to Know“ page has just been redesigned based on input from our Patient Advisory Group. And WOW!

  • Please visit/share this great introduction to the topic. Available here (European visitors, here,  Spanish version, here).

Study
Topic: Medical jargon and patient understanding

  • A recent JAMA cross-sectional study Accuracy in Patient Understanding of Common Medical Phrases showed that participants frequently misunderstood and often assigned meaning opposite to what the clinician intended. “These findings suggest that use of common medical phrases may lead to confusion among patients affecting health outcomes.”

Latest Articles

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Europe
A British Institute of Radiology (BIR) blog just out on breast density authored by DBI European Education Coordinator Cheryl Cruwys. The piece, ‘Why Understanding Breast Density Matters’,  also provides an overview of the DBI/Europe website resources.

Just Published
Out in Radiology Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities, co-authored by MAB member Dr Emily Conant. Beyond breast density, the article describes the range of imaging markers associated with breast cancer risk in digital mammography, digital breast tomosynthesis, whole-breast US, and MRI.

Federal Legislation, New Publication

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Want to get involved?  Check the Find It Early Act webpage for information on how to contact a congressperson, how to schedule a meeting, what to bring, what to ask, and follow up suggestions. This “Lobbying 101” page was developed with feedback from Rep. Rosa DeLauro’s office on best practices and input from our Patient Advisory Group on language.

Newly Published
Out in Radiology, Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis with accompanying editorial by MAB member Dr Regina Hooley. In a meta-analysis of 3D mammography, ultrasound, or MRI to supplement 2D mammography, Hussein et al report results consistent with the literature that screening MRI outperforms anatomic imaging in cancer detection. MRI found 26 cancers per 1000 women screened, with acceptable PPV of biopsy.  Not all women can tolerate MRI, however, and, in their analysis, supplemental screening with either handheld or automated US found 4 cancers per 1000 women screened that were missed on mammography.

Updates in the U.S. and Europe

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U.S. State Density Inform Bill and Insurance Bills
West Virginia has introduced two density “inform” bills; please see DBI’s updated legislation MAP for details. And, insurance bill introductions requiring coverage for expanded breast imaging continue with 20+ bills so far!

Europe: Screening Guidelines
Greece now has a national (organized) screening program. Please find updated information by country in our European Screening Guidelines MAP and TABLE.

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.

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