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.”
Blog
Upcoming Symposium and More
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:
- A conversation with DBI’s Chief Scientific Advisor Dr. Wendie Berg, “The FDA’s rule change requiring providers to inform women about breast density could lead to a flurry of questions” was just published in The Conversation. The comprehensive round up of considerations includes information on what the new FDA ruling entails, how it might affect patient response to mammogram results, a list of risk factors that would make a woman “high risk,” and insurance issues for supplemental screening.
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
As new research is published, the DBI website content is reviewed and edited, including:
- Health Provider FAQ: What is the recommended breast screening for women with disease causing genetic variants? In addition to pathogenic/likely pathogenic variant carriers and their untested first-degree relatives, annual screening MRI is recommended in addition to mammography/tomosynthesis in some subgroups of women. See updated gene/NCCN screening guideline table.
New Research
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
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:
- Podcast: “Why Breast Density Matters” on RadChat, the award winning first therapeutic radiographer led oncology podcast.
- Article: “Breast Density and Cancer Screening” in the Society and College of Radiographers’ Synergy Journal (begins page 14).
FDA National Reporting Standard
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
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.”
European Congress of Radiology
DenseBreast-info.org/Europe will be exhibiting at #ECR2023 from March 2-5. DBI’s European Liaison Dr. Athina Vourtsis, and Education Coordinator Cheryl Cruwys, will be on hand.
- Look for the DBI exhibit stand in the Austria Center (Hall D, level -2).
- Please contact Cheryl Cruwys at +33 643 88 67 85 to schedule a ‘‘meet up.”
Latest Articles
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
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
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
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.
- DBI’s own research published in 2021, Effect of an educational intervention on women’s healthcare provider knowledge gaps about breast density, breast cancer risk, and screening, found important knowledge gaps on the same topic among women’s healthcare providers. For instance, only 29.4% knew risk increases with increasing glandular tissue.
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
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
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
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
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.
DBI’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 DBI 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).