After striving for years for the rights of women to be equitably engaged in breast cancer awareness, knowledge, and communication, we are delighted to welcome EUSOBI recommendations on patient density “inform” and supplemental screening MRI for women with extremely dense breasts. DenseBreast-info.org and DB-i/Europe provide important educational resources to health professionals and women on the implications of breast density and effectiveness of supplemental screening in women with dense breasts. In a comment authored by Drs. Vourtsis and Berg behalf of DenseBreast-info.org, “A change in paradigm of breast cancer screening in European women with extremely dense breasts” (3rd letter in the linked page), the letter also highlights the potential benefits and need for supplemental screening for women with heterogeneously dense breasts.
Blog
Errors in the Canadian Breast Screening Trials
Just out in the Journal of Breast Imaging: DB-I MAB members Drs. Jean Seely and Paula Gordon along with Drs. Peter Eby, Shushiela Appavoo and Martin Yaffe co-author “Errors in Conduct of the CNBSS Trials of Breast Cancer Screening Observed by Research Personnel.” The Canadian trials were used as evidence to discredit screening women in their 40’s.
The startling conclusion:
“These firsthand accounts provide new information confirming that the CNBSS did not consistently and rigorously assess the true efficacy of screening mammography. The staff accounts clarify reasons why the CNBSS results were outliers compared with the six other randomized trials of screening mammography and should not be used as credible scientific evidence to inform health policy.”
Health Literacy Review
Health literacy is the extent to which a person can receive, process, and understand health information to improve communication with their doctors and equip them to advocate for their own well-being. To evaluate DBI patient materials, we have embarked on content review in conjunction with a health literacy expert. This will be a multi-month project, but we wanted to share some early updates to DBI popular content:
- Dense Breasts: 5 Facts You Should Know
- New Question, “I have dense breasts and cancer might be missed on my mammogram. What else can I do?” .
National Physicians Week:
Today begins National Physicians week in the U.S. We recognize and thank DBI’s stellar team of medical advisors and educators! Look for social media posts this week.
Mammogram Reminders and MAB News
Erin Go Bragh!
In light of Covid-caused breast screening delays, DB-I has developed a series of “mammogram reminder” social media posts to encourage screening. Our playful St. Patrick’s Day post is attached.
Medical Advisory Board News
MAB member Dr. Regina Hooley’s recent Letter to the Editor, The Benefits of Early Breast Cancer Detection, was published in The New York Times (fourth letter in the linked page). She and co-author Dr. Susan Harvey weigh in on the “harms” of screening by highlighting the benefits of early detection and distinguishing between overdiagnosis and overtreatment.
New “Inform” Recommendations from EUSOBI!
Europe / Newly Published:
JUST OUT! EUSOBI recommends EU women be “informed” of breast density and supplemental screening considerations: Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Some highlights:
- “Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened.”
- “In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years.”
- “Where MRI is unavailable…ultrasound in combination with mammography may be used as an alternative.”
As a reminder, DB-I-Europe was developed to support such discussions and, among other resources, features educational tools for both European patients and doctors/health providers.
Using Social Media to Educate Patients & Providers
DB-I has a robust social media program to reach and share information with both patients and health providers. Please be an educational resource! DB-I’s educational posts (nearly daily) are intended to be shared. To “follow” us, please visit DB-I pages on Facebook, Facebook/Spanish, Twitter, LinkedIn and Instagram.
Did you know that March 1st is National Pancake Day in the U.S.? DB-I had some light-hearted fun and participated on social media:
New Research and Risk Assessment Tools
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).
New Research Article
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
In The Know with DenseBreast-info Quiz #5
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.
- 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?
- 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).
European Education Efforts
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).
Patient Education Tools
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.
Spanish Educational Efforts
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!
2021 Patient Outreach
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.
“In the Know with DenseBreast-info” Quiz #4
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.
WebMD Article Features DB-i Resources
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.”
European Studies
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