Blog

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.

Video Library in Spanish:
There are 62 million Hispanics in the U.S., and research shows that 71% percent do not speak English at home; nearly 1 in 3 are not fluent in English. To better provide Spanish-language education on dense breasts, DB-I’s Spanish content (https://densebreast-info.org/espanol/) now includes the following Spanish-language videos:

• Patient education video, La Densidad de los senos y el cáncer de mama (Dense breasts and breast cancer)
• Radiological expert video, Todo lo que debes saber acerca de los senos densos (Everything you need to know about dense breasts)
• Individual patient dense breast stories

On that Topic:
One of the takeaways of a recent JACR article, Breast Density Knowledge and Awareness Among Latinas in a Low-Resource Setting was the need to ensure equitable dissemination of health care resources to Latina women undergoing screening mammography. According to the authors, future efforts should be aimed at developing effective resources for patient education about breast density and risk-based screening.  DB-I Spanish-language resources are widely available to address such needs!

Website Visits:
DenseBreast-info.org finished 2021 with just shy of 300,000 website visits.

Patient Outreach:
The most frequently downloaded website tools were those developed for patients: Patient Fact Sheet (multiple languages here), Patient Brochure (print/fold) and the Patient Risk Checklist. We remain strongly committed to developing, providing, and promoting free patient education tools.

The fourth quiz in the collaborative series with OBG Management magazine, In the Know with DenseBreast-info, 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.

• Quiz #1, How is a woman determined to have dense breast tissue?
• Quiz #2, True or false: Breast density increases breast cancer risk
• Quiz #3, In which categories of breast density does tomosynthesis/3D mammography increase cancer detection over standard digital mammography?
• Quiz #4, Average-risk women with dense breasts—What breast screening is appropriate?

Comment in Response
A Jama Oncology viewpoint article, Mammographic Density Laws and Inclusion—Time for Change, drew comment from DB-i’s medical advisory board members, Drs. Wendie Berg, Paula Gordon and Daniel Lehrer, with helpful review by Gretchen L. Gierach, PhD. Please find their response, Time for Better Screening for All Women, in the comment section.

• New AuntMinnie story, Ultrasound Jostles for Bigger Role in Screening Dense Breasts, details the role of ultrasound in imaging dense breasts and also includes mention of the DB-i team Jama Oncology comment.

 

Patient Reach Out:
WebMD, a leading online source of health and medical news, invited DB-i’s Executive Director JoAnn Pushkin to share her story of dense breasts, a missed cancer, and what women should know about breast density. Available here: Why Breast Density Matters.

New Study:
Just published in Annals of Internal Medicine,  Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling. According to the authors, “Results suggest that, in self-identified Black women, initiation of earlier screening than is presently recommended for the overall U.S. population by the USPSTF or the American Cancer Society [i.e., by age 40] can reduce mortality disparities and maintain acceptable benefit-harm tradeoffs.”

Reminder:
UK study, A study comparing breast scans to diagnose small breast cancers in dense breasts (BRAID), is still in the recruitment phase. The study is open to women who have had breast screening as part of the NHS Breast Screening Programme and are between 50-70 years old with dense breasts. Participants will receive randomized follow up with either ABUS, CESM, ABB-MRI or just mammography.

Of Interest:
RSNA presentation from DB-i’s European Education Supporter, Dr. Erkin Aribal from Acibadem University in Turkey, on a large retrospective study of AI performance in negative screening mammograms. Findings suggest AI could reduce interval cancer rates, particularly relevant in middle-income countries with workforce shortages: https://www.auntminnie.com/index.aspx?sec=prtf&sub=def&pag=dis&itemId=134436&printpage=true&fsec=rca&fsub=rsna_2021

Free CME/CE:
A reminder that those in need of year-end credits may be looking for educational opportunities. Be the resource! Please share the FREE on-demand CME/CE course, Dense Breasts and Supplemental Screening with those in your network. The very popular course is designated for 1.5 AMA PRA Category 1 credits or 1.5 ASRT Category A credits.

OBG Management / DB-i Quiz:
The third quiz in the collaborative series with OBG Management magazine, In the Know with DenseBreast-info, 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.

• Quiz #1, How is a woman determined to have dense breast tissue?
• Quiz #2, True or false: Breast density increases breast cancer risk
• Quiz #3, In which categories of breast density does tomosynthesis/3D mammography increase cancer detection over standard digital mammography?

Canadian National Breast Screening Study
News: Flaws in the two Canadian “randomized” trials whose results formed the basis of the country’s breast screening recommendations are detailed in a research article published in the Journal of Medical Screening, The randomized trial of mammography screening that was not—A cautionary tale, authored by DB-i’s medical advisors Drs. Jean Seely and Paula Gordon, and Drs. Martin Yaffe, Shushiela Appavoo and Daniel Kopans. According to the authors, the trial results “should no longer be used in meta-analyses of screening nor to inform policies on breast cancer screening.”

European Study
A Swedish prospective study, Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study, will be awarded the Margulis prize at RSNA as the outstanding paper published in Radiology this past year. The study reports on the importance of regular, consecutive breast screening schedules to reduce premature deaths from breast cancer. Conclusion, “Women participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk.”

A 2021 DBI education goals was to expand our selection of multi-media educational tools in Spanish. In addition to the recently launched educational video, La Densidad de los senos y el Cáncer de Mama, the website now features 40+ Patient Questions and Answers in Spanish. Next up will be a selection of patient experience and medical expert perspective videos in Spanish. Please feel free to share these tools!

Ten years ago, at the request of DB-i’s JoAnn Pushkin, the topic of providing women breast density information after their mammograms was added to the agenda of the FDA’s National Mammography Quality Assurance Advisory Committee. At that meeting, consensus was reached that a woman’s breast density should be provided to her and her health provider. It is 10 years later and the FDA’s final rule for a single national “density” reporting standard is still not yet finalized. Learn more about DB-i efforts here.

A Word About Accuracy
Breast Cancer Awareness Month is behind us, and we were dismayed by misinformation on the topic posted by certain patient advocacy organizations. It is truly unfortunate, and we point this out to reassure you that DB-i’s very hard working Medical Advisory Board is consistently engaged in reviewing all of our website content to ensure the information we provide always maintains the highest standard of accuracy and integrity.

Questions about supplemental breast imaging access and insurance billing codes are among the most often asked queries that we receive from U.S. website visitors. To provide some clarity and actionable information, we have developed a new FAQ, What are insurance billing codes for additional screening tests? for both Patients and Health Providers on the topic.

OBG Management / DBI Quiz
The second quiz in the collaborative series with OBG Management magazine, In the Know with DenseBreast-info, is now live. Each month’s quiz addresses a knowledge gap identified through the DBI 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

News! An update to DBI‘s comprehensive and popular table, Cancer Detection by Screening Method, went live last week. By modality, the table shows a summary of expected additional cancer detection (in women of different breast density), effect on the false positive recall rate, and impact on interval cancer reduction using screening imaging methods after standard 2D mammography. For future reference, it is located within our Tech Tab section.

A Note About DBI Map Content
Inform and insurance legislation details featured on the DBI website are based on our legislative analysis of each law. Legislative language can be detailed, nuanced and open to interpretation. The current DBI ”inform” law count of “38 states and Washington DC” is based on that analysis; others’ analyses may yield a different total. We therefore request that any mention of DBI’s map data or state count be “source specific” and indicate that it is “Based on DenseBreast-info.org analysis” and/or include a DBI website citation.