Blog
Updates to our Screening Guidelines Table
Breast Cancer Management During COVID
COVID-19
See below for some early guidelines on breast cancer management during a pandemic:
- An executive summary from the American Society of Breast Surgeons, Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic
- Guidelines from the Canadian Society of Breast Imaging (CSBI) and the Canadian Association of Radiology (CAR), Guidelines for Breast Imaging during the COVID-19 Pandemic
- An editorial published in the European Journal of Breast Health, Breast Cancer Diagnosis, Treatment and Follow-Up During COVID-19 Pandemic
Density Inform Effectiveness Studies
In recent months there were several research studies detailing the “effectiveness” of density inform legislation. When we analyzed the studies, we found that they did not distinguish between laws that only provide general, non-personal, or incomplete inform vs. those state laws that do. Read DB-i’s position statement and call for standards in studies on the topic HERE.
New Medical Advisory Board Member and Online Learning Opportunity
We are delighted to announce that Dr. Georgia Spear has joined the DenseBreast-info.org Medical Advisory Board. Dr. Spear is Chief, Department of Breast Imaging, North Shore University Health System and Clinical Assistant Professor of Radiology at University of Chicago.CME/CE OpportunityA productive use of any upcoming “down” time may be to earn some credits. If interested in promoting DB-i’s comprehensive CME opportunity, Breast Density: Why it Matters, and so that you can be a resource for colleagues, download our CME/CE announcement flyer and share within your communities.
“Breast Density: Why It Matters” Online Course
Are you and your colleagues up to date on the screening and risk implications of dense breast tissue?
- Click here for information on our online CME Course, Breast Density: Why It Matters.
- Download this flyer to share this information with your colleagues.
Dense Breasts: Recent Publications and Articles
Diagnostic Imaging/Europe article
An article authored by DB-i European Liaison, Dr. Athina Vourtsis, and Chief Scientific Advisor, Dr. Wendie Berg, appeared in the February/March 2020 online edition of DI Europe. The article, Using education to overcome unequal access to supplemental screening for women with dense breasts, takes an in-depth look at the need for education in addressing the importance of supplemental screening for women with dense breasts. A link to the article, courtesy of DI Europe, can be found within our Press page (top story under “Featured Pieces”).
More Recent Density Research Publications (and Subsequent DB-i Website Updates)
- Choudhery S, Patel BK, Johnson, M et al. Trends of Supplemental Screening in Women With Dense Breasts. JACR. 2019.12.031
- Comstock CE, Gastonis C, Newstead GM et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 2020;323(8):746-756.
We’ve updated the following sections of our website to include the above JAMA Network publication:
- Patient Questions and Answers, Q22. If I have a 3D mammogram (tomosynthesis), do I also need a screening ultrasound or MRI?
- Health Care Providers FAQS, Q31. If 3D mammography (tomosynthesis is performed, will a patient also need a screening ultrasound?
- Screening Technologies, Breast MRI
Advisory Board Update and EuroMinnies
We are pleased to announce the addition of DaCarla M. Albright, MD, FACOG, OB/GYN to the DenseBreast-info Medical Advisory Board. Dr. Albright serves as an Associate Professor and Assistant Dean for Wellness at the University of Pennsylvania Perelman School of Medicine in Philadelphia, PA. She maintains an active practice as a specialist in Obstetrics and Gynecology and has been involved in the development of educational programs addressing the importance of counseling patients about their risk for breast cancer including their breast density, the importance of breast cancer screening, and the imaging tools available for patients at risk. We all look forward to working with Dr. Albright and to the unique perspective she will bring to the Medical Advisory Board.
Our congratulations to Prof. Dr. Christiane Kuhl, one of DB-i’s Education Ambassadors for Germany, who has been selected to receive the 2020 EuroMinnies award as “the Most Influential Radiology Researcher.” She will receive her trophy at ECR2020 in Vienna in March. The interview with Prof. Kuhl was published in AuntMinnieEurope on February 25, 2020.
A Closer Look at State Density Inform Bills
News from Abroad
Canada:
On Feb 13th, DB-i Medical Advisory Board member, Dr. Paula Gordon, will be presenting a free webinar, Breast Screening and Breast Density, in conjunction with the Canadian Cancer Survivor Network. For more info/registration: https://register.gotowebinar.com/register/5179589676334572812
Europe:
Professor Boris Brkljačić, ESR President and DB-i European Education Ambassador for Croatia, was featured in the January/February issue cover story of Health Care Business News. Professor Brkljačić answered questions about the upcoming ECR conference (March 11 – 15 in Vienna) and shared his insights about the future of the European radiology community.
National Reporting Standard Updates on Timeline
UPDATE: National Density Reporting Standard
Senator Dianne Feinstein was the lead sponsor on federal legislation requiring the FDA to develop breast density reporting language to be included in patient letters and health provider reports. The FDA made public the proposed rule in March 2019, and we now wait to learn what the FDA’s final rule (scheduled for Sept 2020) and implementation period (proposed, 18 months) will be. We will keep you posted on our work on this important issue.
2020 Referring Community Reach Out:
As it is most often to a referring provider that a woman addresses her “density” questions after a density notification, a DB-i 2020 priority is reaching referring providers to share our educational resource. For the first time, DB-i will have a booth at both NCoBC and ACOG, stop by to say hello!
More Questions on Density Disclosure
CMAJ Article Questions Effectiveness of Density Disclosure:
An article in the Canadian Medical Association Journal (CMAJ), “Breast density disclosure may do more harm than good,” drew powerful responses from Dr. Paula Gordon, DB-i Medical Advisory Board member and Volunteer Advisor for Dense Breasts Canada, and Dr. Martin Yaffe, Research Scientist at University of Toronto, Ontario Institute for Cancer Research. DB-i applauds them both for their responses that effectively highlights the implications of dense breasts and addresses concerns about the need for women to be aware of their density status.
2019 Website Analytics:
In 2019 the U.S. DB-i website had 214,000 visits, an 18% increase from 2018. We are on track for a 20% increase in visits for 2020. Our increased emphasis on social media was also effective, as we saw substantial growth in Facebook (63%), Twitter (33%) and LinkedIn (118%). Our thanks to all Supporters and Advisors for helping increase awareness of this educational resource.
Dense Breast Notification Laws
Several recent studies have been published reporting on survey results to determine the “effectiveness” of breast density notification (DBN) laws, comparing levels of awareness and understanding between DBN and non-DBN states. These studies found that although the level of awareness of breast density did increase in women in DBN states, there was no increase in the understanding of the clinical implications of breast density. In addition, several studies have shown no increase in screening ultrasound utilization.
To distinguish between general information about breast density and patient-specific notification of breast density results, DB-i has provided perspective for articles recently published in DotMed, Diagnostic Imaging and AuntMinnie. In addition, there is a Letter in Press to Academic Radiology, and a Letter to the Editor has been submitted to the Journal of General Internal Medicine.
There is much interest in the topic and while you can look forward to a more detailed, published DB-i response, below are some general thoughts on the studies:
1. While inform laws were intended to raise a woman’s awareness about dense breasts, they were not intended to be a substitute for a conversation with her provider.
2. Not all 38 state laws provide the same information or level of notification to patients. The recent studies do not distinguish between DBN laws that actually inform a woman she herself has dense breasts vs. those that only provide general information about breast density. For example, see the chart below for the Tri-State area.
3. To ascertain the impact of personal notification, an analysis of state inform laws that do provide full information (personal notification of density and information on masking, risk and supplemental screening), compared to states with no DBN, is needed. Specifically:
• 6 state laws require only general information about breast density be provided to the patient without informing the patient if she, herself, has dense breasts
• 6 state laws do not provide unambiguous language about the masking effect of cancers due to dense tissue
• 23 states laws do not mention that “supplemental screening” may be a topic to discuss with a health provider
4. Referring physicians remain confused about supplemental screening. Some of this confusion results from lack of a national guideline recommending screening ultrasound in women with dense breasts. Women at high risk should be referred for supplemental screening MRI regardless of breast density, in accordance with national guidelines.
These study results highlight the need for a national reporting standard that assures all U.S. women receive the same minimum threshold of information. DB-i was developed to provide information to guide new discussions occurring as a result of “inform” notifications.
DB-i is pleased to be recognized by the media as a leading authority on dense breasts and dense breast legislation and we will continue to be an active voice on the topic to facilitate a better understanding and reporting of the complexities of this important topic.
State Update: West Virginia Introduces Law
2020 State Legislation:
The state of West Virginia has just introduced legislation (HB 2224) addressing both patient density notification and ultrasound coverage. Thirty-eight states and the District of Columbia currently have active laws, though they vary in terms of the scope of information they provide. For more information, please visit DB-i’s interactive MAP.
U.S. Federal Reporting Standard:
Many of you have asked for an update on the effort for a national reporting standard. As you know, the “Open for Public Comment” period on the March 2019 proposed rule concluded in June 2019 and the FDA is now reviewing comments. According to the FDA’s timetable, the final rule is scheduled for Sept 2020 and at that time the implementation period will also be made public. The proposed rule indicated an 18-month implementation period, the final rule may differ.
Educational Resources Available for Download
DB-i extends its outreach to patients and providers by featuring key content in downloadable PDF format. What educational tools are the most popular? We thought recent analytics might be of interest. In the past 4 weeks:
- There have been close to 350 downloads
- Almost half of “download” traffic comes from “organic” sources (e.g. internet search, unpaid social media), indicating we are reaching quality audiences.
- Download popularity by key content:
1. Legislation Inform/Insurance Table
2. Patient Risk Checklist (English)
JACR Publication on Density Awareness and ECR2020
JACR Publication on Breast Density Awareness:
A November 19, 2019 online publication in the Journal of the American College of Radiology (JACR) found an increase in breast density awareness in women aged 40 to 70 years in the 5-year period from 2012 (57.5%) to 2017 (65.8%). The study, Breast Density Awareness, Knowledge, and Attitudes Among US Women: National Survey Results Across 5 Years, found that although knowledge of breast density’s impact on risk increased, there was no increase in knowledge about the masking effect of breast density.
This survey highlights the vital need for patient education provided by DB-i and the importance of directing women to this resource. Among other efforts to highlight our educational tool, DB-i participates in an ongoing project with Google Ads to ensure that “DB-i” populates as the first/second listing when terms “dense breasts” or “breast density” are searched for the first time from an IP address. In addition, our frequent social media posts on Twitter, Facebook and LinkedIn have been effective in increasing awareness of the resources available on our site.
ECR2020 Meeting:
Our poster, “European expansion of DenseBreast-info.org educational resource” will be featured as both an electronic poster (EPOS) and Voice of EPOS at the ECR meeting in March. Look for us there!
CMIST Trial and ESR Leadership Meeting
Plans for CMIST Trial Announced:
The American College of Radiology (ACR) recently announced plans for a clinical trial to determine if contrast enhanced spectral mammography (CESM) screening provides more accurate cancer detection compared to the combination of digital breast tomosynthesis and whole breast ultrasound in women with dense breasts. The Contrast Enhanced Mammography Imaging Screening (CMIST) Trial, planned to begin in spring 2020, will be managed by the ACR Center for Research and Innovation and will be supported by the ACR, Breast Cancer Research Foundation and GE Healthcare.
ESR Annual Leadership Meeting:
DB-i was well represented at the ESR Annual Leadership meeting in Genoa, which was attended by Cheryl Cruwys, DB-i’s European Educational Coordinator, along with European Education Ambassadors Prof. Michael Fuchsjäger (Austria), Prof. Boris Brkljačić (Croatia) and Dr. Magnús A. Lúðvíksson (Iceland). Cheryl attended as part of the ESR Patient Advisory Group, committed to developing and supporting ESR patient-focused initiatives.