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ASRT Course, New ABUS Study

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Health Professional Education
DBI efforts to build educational opportunities for all health professionals continue in advance of the FDA’s “dense breast” reporting requirement. DBI has collaborated with the American Society of Radiologic Technologists (ASRT) to develop the course  Dense Breasts, Supplemental Screening and New MQSA Reporting Requirements. Find the course on DBI’s Provider Education Video page.

Research
Coauthored by DBI’s European Education Ambassador from Turkey, Dr. Erkin Aribal, a study of nearly 3500 women with nonfatty breasts ages 40 and older found that either automated breast ultrasound (ABUS) or digital breast tomosynthesis (DBT) alone each detected 84% (26/31) of cancers, with all 23 screen-detected invasive cancers seen on ABUS and 20 screen-detected invasive cancers seen on DBT. ABUS had a higher recall rate of 12.4% versus 6.0% for DBT.  Combining DBT plus ABUS found nearly 1 additional cancer per 1000 women screened compared to either DBT or ABUS alone (8.4/1000 vs. 7.5/1000) and increased recall rate to 14.9%.

New Studies

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Recently Published

Two recently published studies that might be of interest –

Patient Experience of Women with Dense Breasts Undergoing Screening Contrast-Enhanced Mammography:
A study from the University of Virginia, co-authored by DBI medical advisory board member Dr. Jennifer Harvey, found that most women with dense breasts who underwent contrast-enhanced mammography reported a positive experience. Over 90% reported minimal or no unpleasantness, indicated they would probably undergo CEM in the future if the cost was similar to a traditional mammogram, and that they would very likely recommend it to a friend.

AI-based selection of individuals for supplemental MRI in population-based breast cancer screening: the randomized ScreenTrustMRI trial:
A randomized study conducted by researchers at the Karolinska Institute found that using AI to select women for supplemental MRI screening rather than density alone resulted in 4 times as many cancers detected by MRI (64 vs. 16.5 per 1000). Selecting women based on a high AI score was cost effective, resulting in a cost per cancer detected similar to screening mammography.  This study will ultimately report on the effect of MRI (if any) on reducing advanced breast cancers, including interval cancers.

New State Insurance Laws

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State Insurance Laws
NEWS on insurance laws for expanded breast imaging in Louisiana, Mississippi, New Hampshire, and Nevada. Currently, 32 states + DC have insurance laws for expanded coverage for either screening or diagnostic imaging. Alaska may be next – that bill is on the governor’s desk – stay tuned!

  • Full details by state HERE
  • Insurance map visual HERE

Amended “Inform” Law, New Study

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Rhode Island Density Inform Law Amended
In preparation for the FDA’s new dense breast reporting standard going into effect Sept 10, 2024, Rhode Island has amended its existing “inform” law. The Rhode Island inform law will now defer to the FDA’s national reporting standard. Please see DBI’s State Law Map or Table for details.  As previously mentioned, existing state density inform laws may remain in effect in addition to the FDA requirement unless that state law specifically defaults to the new FDA standard, expires, or is repealed.

Just Published
A retrospective study just out in Radiology,  Comparison of Mammography and Mammography with Supplemental Whole-Breast US Tomography for Cancer Detection in Patients with Dense Breasts, evaluated the performance of US tomography (UST)  combined with full-field digital mammography (FFDM) in a reader study in women with dense breasts. The addition of UST improved cancer detection over FFDM alone and the detection rate was comparable to other ultrasound screening methods.

NEW! Health Provider Video Series

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The FDA requirement for density inform is around the corner, and health providers should be preparing for new patient/provider conversations about what it means and what to do. To assist,  DBI has just launched a series of 6 short educational videos for health providers, available HERE.

Topics are:

  • Video 1,  Dense Breasts: Why They Matter
  • Video 2,  State Density Inform Laws and the National Reporting Standard in the USA
  • Video 3,  Educating Patients About Dense Breasts and Supplemental Screening
  • Video 4,  Breast Cancer Risk Assessment and Screening Guidelines
  • Video 5,  Supplemental Screening in Women with Dense Breasts
  • Video 6,  Insurance Coverage and Billing Supplemental Screening in the USA

As a reminder, these complement newly launched patient content:

Review Article

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Newly Published
New review article out The paradox of MRI for breast cancer screening: high-risk and dense breasts—available evidence and current practice details the evidence supporting screening MRI for women with dense breasts. Should the evidence be enough for guidelines and implementation? As a reminder, in Europe, EUSOBI’s most recent screening recommendations call for supplemental MRI or ultrasound for women with category C or D (dense) breasts, with an explicit recommendation of MRI at a minimum of every 4 years for women with extremely dense breasts.  In the USA, the American College of Radiology states “For women with dense breasts who desire supplemental screening, breast MRI is recommended.”

NEW Patient Technology Info

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NEW! Screening Technology Info for Patients
The FDA requirement for density inform is around the corner, and with it will come new patient/provider conversations about what it means and what to do. To gear up, DBI has developed simplified, introductory content for patients, Screening Tests After a Mammogram. We extend thanks to our hardworking Patient Advisory Group who devoted much time and input into its development. Please visit and share the new page!

Breast Cancer Screening Updates from Canada

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While Canadian breast cancer screening advocates celebrated the Canadian Cancer Society’s endorsement of lowering the screening age to 40, unfortunately the soon-to-be-released Canadian Task Force guidelines are unlikely to do the same. Ten out of twelve provinces with screening programs have lowered the screening age to 40, but it is still important that the Task Force do so as well, since Task Force guidelines would inform primary care providers who often discourage breast screening until the age of 50. Despite the increasing incidence of women in their 40s presenting with advanced breast cancers, the Task Force does not seem poised to lower the recommended screening age.

TOCEM Interim Analysis

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Just Published in Radiology
Addition of Contrast-enhanced Mammography to Tomosynthesis for Breast Cancer Detection in Women with a Personal History of Breast Cancer: Prospective TOCEM Trial Interim Analysis. Women with a personal history of breast cancer are at higher risk for second cancers and for having that cancer missed on mammography. Interim analysis from the ongoing TOCEM study, led by DBI Chief Scientific Advisor Dr. Berg, shows very favorable results using annual screening contrast-enhanced mammography (CEM) after tomosynthesis, with added cancer yield of 7/1000 in year 1 and 4/1000 in years 2 and 3, small median invasive tumor size of 0.6 cm, mostly node negative. Added recalls occurred in 6.6% women year 1 and 5% in subsequent years.

USPSTF Recommendations, State Insurance Laws

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USPSTF Guidelines / Editorial by Dr. Wendie Berg
The United States Preventative Services Task Force (USPSTF) has released a Task Force Recommendation Statement for breast screening.  DBI’s Chief Scientific Advisor, Dr Wendie Berg, was invited to respond in an editorial on the key advances and opportunities to enhance breast screening guidelines moving forward: USPSTF Breast Cancer Screening Guidelines Do Not Go Far Enough. [See DBI announcement for a summary of details.]

U.S. State Insurance Laws
Two new states, Iowa and Vermont, have enacted insurance laws for expanded breast imaging coverage after a mammogram.

  • Full details by state HERE
  • Insurance map visual HERE

EUSOBI Updated Guidelines, Insurance Laws, NYT Article

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EUSOBI Updated Breast Cancer Screening Recommendations
Please see this article in Diagnostic Imaging for a summary of the new EUSOBI recommendations. While 2022 recommendations focused specifically on women with extremely dense breasts, updated recommendations aimed to give a general overview of current recommendations for screening all women – including risk assessment at a young age, general population screening, and high-risk screening for women with BRCA mutations.

New York Times
A recent article, Some Older Women Need Extra Breast Scans. Why Won’t Medicare Pay?, published in the New York Times garnered so much interest and so many comments that a follow up article has been scheduled. DBI has provided quotes and material for both.

DBI on Capitol Hill, Density Request Forms

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The World’s Leading Resource on Dense Breasts, Now Leads the Fight for the Find It Early Act
DBI had a full schedule on Capitol Hill last week meeting with key Congressional members. The federal bill would ensure all health insurance plans cover screening and diagnostic imaging with no out-of-pocket costs for women with dense breasts or higher risk for breast cancer. WE NEED YOU TO TAKE ACTION. Please share your perspective/examples of denials for coverage for supplemental imaging, resulting delayed screening, unexpected insurance costs, etc., with your congressperson. FYI, congressional members have made it clear that personal direct reach outs are much more effective than petitions. Please contact your congressperson and ask for them to support the bill, learn how HERE.

Patient Density Request Forms
Women out of the U.S. have asked for a resource to request their breast density after their mammograms. DBI features 5 versions of a Patient Density Request Form for specific health systems, the newest version in Arabic.

Density Request forms are available as free downloads:

Kentucky Insurance Law, AI for Supplemental Screening

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New U.S. State Insurance Law
The state of Kentucky becomes the 28th state to enact a law requiring some level of insurance coverage for additional breast imaging after a mammogram.

  • Full details by state HERE
  • Insurance map visual HERE

New Study
Just out in Radiology, study Use of an AI Score Combining Cancer Signs, Masking, and Risk to Select Patients for Supplemental Breast Cancer Screening. This large retrospective study found that an AI-based risk model incorporating cancer signs, masking and risk was superior to breast density alone in identifying patients with a negative screening mammogram who were likely to develop subsequent breast cancer. The AI-based risk model, known as AISmartDensity, identified 33% of future cancers compared to 13% for the density-based model.

SBI Meeting, Please Visit Booth #505

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Please stop by at SBI!

On September 10, 2024, dense breast reporting to patients and their providers will become a U.S. federal requirement. In Canada, 12 out of 12 jurisdictions will soon be telling women their breast density.  These developments will lead to new patient/provider conversations about the screening and risk implications of dense tissue and supplemental screening. Providers should be prepared to either be a resource or recommend one on the topic. Are you ready?

DenseBreast-info.org is the world’s leading medically sourced website on the topic and provides free educational tools for both patients and providers. Please visit us in booth #505 to learn more.

Canada Inform, ILC Imaging, Research Grant

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Density Inform / Canada
Good news from DenseBreastsCanada! Dense breast notification from coast to coast goes into effect this summer in Canada! Well done to advocates Jennie Dale and MAB member Dr. Paula Gordon for their tireless efforts.

JBI Article on Imaging for ILC
In an article co-authored by MAB members Drs. Wendie Berg and Lars Grimm, the majority of SBI member radiologists surveyed felt that additional screening beyond mammography was needed to detect ILC in dense breasts, to image extent, and in women of all breast densities with treated ILC.

New Research Grant
Congratulations to Dr. Wendie Berg on the award of a research grant from the PA Breast Cancer Coalition as co-PI with Dr. Shandong Wu to study the use of AI added to contrast-enhanced mammography to reduce false positives in screening!