DBI’s free downloadable patient brochure has just been updated! The single fold brochure (print/fold) is available in both English and Spanish. We extend thanks to our Patient Advisory Group and Medical Advisory Board for their input and perspectives!
Blog
DBI Spanish Language Materials & Support
News! The DBI Spanish language site SenosDensos.org is updated and more accessible. There has been a substantial increase in visits to DBI’s Spanish content and we are ready to address these educational needs!
In recognition of his long-term commitment to DBI Spanish language content development and expansion, we are delighted to announce that MAB member Dr. Daniel Lehrer, Breast Imaging Specialist and Medical Director at CERIM in Argentina, is now DBI Spanish Language Advisor. His tireless work assures that DBI content is, and will be, available to Spanish speaking women all over the world.
Research and MAB News
New Research
Finding it early saves lives and money. New research out in Current Oncology, Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing details that “…the cost of BC treatment is many orders of magnitude less when BC is diagnosed at an earlier stage, and that costs increase exponentially with stage. The magnitude of difference in cost for treatment of late-stage compared to early-stage BC has been previously noted to be 3–4 times; however, our study shows a cost differential of up to 36 times in magnitude when DCIS is compared with stage IV.”
Welcome!
DBI welcomes new Medical Advisory Board members Dr. Sheila Appavoo and Dr. Lars Grimm and welcomes back Dr. Jennifer Harvey! Our hardworking volunteer MAB members contribute to and review all website content.
DBI Study and Article, New Research
In Case You Missed it
Two DBI initiatives on risk assessment and supplemental screening published in the Journal of Breast Imaging continue to be popular:
- Research: Effect of an Educational Intervention on Women’s Health Care Provider Knowledge Gaps about Breast Cancer Risk Model Use and High-Risk Screening Recommendations
- Article: Implementing the National Dense Breast Reporting Standard, Expanding Supplemental Screening Using Current Guidelines, and the Proposed Find It Early Act
Just Published
Out in Radiology, Comparative Performance of Contrast-enhanced Mammography, Abbreviated Breast MRI, and Standard Breast MRI for Breast Cancer Screening. Performance metrics were compared between pooled CEM and AbMRI evaluations from 246 participants (492 interpretations respectively) and 246 standard MRI evaluations from a single reader abstracted from the medical record. While the study found that the cancer detection rate and sensitivity of CEM was lower compared with standard MRI, importantly, readers were trained on CEM just prior to the study whereas MRI was used during the reader’s regular clinical practice. Differential experience interpreting CEM vs. MRI may have resulted in detection bias impacting the findings and pointing to the need for more radiologist training before widespread CEM use.
DENSE Trial
A study of women with extremely dense breasts, the Dutch DENSE trial, has shown that adding MRI to mammography every two years improves cancer detection and reduces interval cancer rates. In a secondary analysis published in Radiology, women in the top third of enhancing volume of breast tissue on MRI were twice as likely to develop breast cancer as those in the lowest third. As incoming DBI MAB member Dr. Lars Grimm points out in an accompanying editorial, it is important to consider combinations of breast density and other risk factors that qualify women as “high risk” and therefore eligible for continued screening MRI under current guidelines.
#WorldDenseBreastDay 2023; Just Published
World Dense Breast Day, sponsored by DenseBreast-info.org, is now on the National Day Calendar. The one-day social media event will take place on Wednesday, September 27th. The purpose of the day is to use the power of social media to raise awareness about dense breasts and share medically sourced educational resources. Please mark your calendars! For more info and details about the worldwide success of last year’s inaugural event, click HERE.
Just Published
Important paper coauthored by DBI MAB member Dr. Jean Seely, Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years, showing reduced breast cancer deaths in Canadian provinces screening women 40-49 compared to those starting at age 50. “Decisions around BC screening in women in their 40s must weigh the potential harms and benefits of screening; however, this is not possible without accurate information concerning the impact of BC on mortality in women aged 40-49 years.”
NCCN Updates; South Australia News
South Australia
Breast Screen SA has announced that beginning August 8th 2023, South Australian women will be informed, in all screening clinics, of their individual breast density category.
Screening flowchart
The Who Needs More Screening? flowchart has been updated to incorporate the recently released NCCN guidelines. The flowchart provides a roadmap for screening women with dense breasts or at higher risk and represents the consensus opinion of our Medical Advisory Board.
Density “Inform” in Canada
News Out of Canada
Ontario, Canada’s most populated province, has become the 7th province to require notification about breast density to women after screening mammography. Women will be informed of their specific density category (A, B, C or D) and the associated risks. Further, a draft recommendation to provide supplemental screening for women in category D (extremely dense breasts) is expected to be finalized in the Fall.
Two additional provinces, Saskatchewan and Newfoundland/Labrador have also committed to begin density notification in 2023. That will bring the total number of provinces with some level of density “inform” requirement to 9 (out of 10). Please visit DenseBreastsCanada.ca for more info.
Find It Early Act (HR 3086)
A reminder that The Find It Early Act needs your support. This bill would ensure that all U.S. health insurance plans cover screening and diagnostic breast imaging with no out-of-pocket costs for women with dense breasts or at higher breast cancer risk. Your congressperson would benefit from hearing your perspective about the legislation. In-person visits or phone calls from constituents are motivating to elected officials. And, representatives that sign on as bill co-sponsors help the bill’s momentum.
Please take action: See DBI’s Find It Early Act webpage for “Lobbying 101” info on how to contact a congressperson, how to schedule a meeting, what to bring, what to ask, and follow up suggestions.
NCCN Guidelines; Missouri insurance law
Updated National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnosis guidelines just out (accessible with free registration). For average risk women, the screening guideline includes: “Consider supplemental screening for those with heterogeneously or extremely dense breasts.” And for women at increased risk, “Consider contrast-enhanced mammography (CEM) or molecular breast imaging (MBI) for those who qualify for but cannot undergo MRI. Whole breast ultrasound may be done if contrast-enhanced imaging or functional imaging is not available/accessible.”
U.S. State Insurance Law
A new insurance law for no-cost breast imaging has been signed into law in Missouri. While Missouri has an existing law for expanded breast imaging, this act “prohibits cost-sharing requirements under coverage provided for diagnostic breast examinations, supplemental breast examinations, or low-dose mammography screenings.” Exceptions apply. Please see DBI’s Legislative Info tab for updated details.
New RI Insurance Law & More
U.S. State Insurance Law
A new insurance law for expanded breast imaging has been signed into law in Rhode Island (copays/deductibles apply). Please see DBI’s Legislative Info tab for updated details.
Just Published
New in JACR, authored by DBI’s Chief Scientific Advisor Dr Wendie Berg, Analytic Hierarchy Process Analysis of Patient Preferences for Contrast-Enhanced Mammography (CEM) versus MRI as Supplemental Screening Options for Breast Cancer. The study showed that 70% of women who had both CEM screening and MRI preferred CEM. 97% of women with claustrophobia favored CEM. For women for whom positioning was most important, only 54% favored CEM. Healthcare providers should include discussion of these factors as part of shared decision making with patients desiring supplemental screening.
Educational Opportunities
- The Association for Medical Imaging Management (AHRA) 50th anniversary annual meeting – Executive Director JoAnn Pushkin’s presentation, Dense Breasts: New FDA Reporting Standard, Insurance Laws, Educational Tools, will be on Sunday July 9th.
- In collaboration with the National Women’s Health Network (NWHN), DBI will participate in webinar Find It Early, on Friday July 14th from 12:00-1:00pm/EST. Keynote Speaker Rep. Rosa DeLauro, sponsor of the Find it Early Act, will be joined by DBI’s JoAnn Pushkin and NWHN’s Denise Hyater-Lindenmuth.
Updated Screening Flowchart & Recently Published
Who Needs More Screening?
Just updated! One of the most popular DBI website tools is the screening decision support flowchart Who Needs More Screening?. The flowchart has just been updated and can be found in the For Providers tab. In the absence of national screening guidelines for women with dense breasts or at higher risk, the flowchart provides a roadmap and represents the consensus opinion of our Medical Advisory Board.
Recently Published
Analysis of over 2.6 million mammogram results from the Breast Cancer Surveillance Consortium confirms greater prevalence of dense breasts in Asian women (66%) than non-Hispanic (NH) White women (45%), Hispanic women (45%), or Black women (37%). Breast density is inversely related to body mass index (BMI) and decreases with age and menopause. After correcting for BMI, age, and menopausal status, Black women were more likely to have dense breasts than NH White or Hispanic women. https://www.ncbi.nlm.nih.gov/pubmed/37284771
Nebraska insurance law, Just published
State Insurance Law
Legislation for expanded breast imaging insurance coverage has been signed into law in Nebraska. Please see DBI’s Legislative Info for updated map and table details.
Just Published
In Cancer, coauthored by DBI MAB member Dr Sally Herschorn, Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Many women at high risk of screening mammography failure do not currently undergo supplemental screening beyond mammography. Health care provider and patient awareness of other breast cancer risk factors beyond breast density, including family history and prior benign biopsies, is important in identification of women at high risk of mammography screening failure (interval cancer or advanced breast cancer) who should be recommended for supplemental screening with ultrasound or especially MRI. It is important to recognize that limiting supplemental screening to women at intermediate- to high-risk by the BCSC model would fail to identify 30-40% of women with dense breasts who will experience interval cancer and about 60% of all women who will develop advanced breast cancer.
Canadian Task Force Guidelines, Of Interest
Canada
The Canadian Task Force, Canada’s source of evidence-based clinical prevention guidelines for primary care providers, just announced it is “fast tracking” updates to their 2018 breast cancer screening guideline. Draft recommendations are due in late fall 2023.
Of Interest
- Radiology: In a study published in Radiology, Comparison of Mammography AI Algorithms with a Clinical Risk Model for 5-year Breast Cancer Risk Prediction, of 13,628 normal mammograms from 2016, any of five AI algorithms performed better than the BCSC model at identifying the 193 women who would develop breast cancer within the next five years, but at the individual level, only 63-67% of women who developed cancer were identified with AI, compared to 61% with BCSC model.
- European Radiology: A multi-reader study, Can incorrect artificial intelligence (AI) results impact radiologists, and if so, what can we do about it? A multi‐reader pilot study of lung cancer detection with chest radiography, detailed when AI is wrong, radiologists make more errors than they would have without AI. Based on human factors psychology, the publication provides “evidence for two AI implementation strategies that reduce the deleterious effects of incorrect AI.”
- JAMA: New study published, Longitudinal Analysis of Change in Mammographic Density in Each Breast and Its Association With Breast Cancer Risk, found that over a 10-year period, breasts that later developed cancer had significantly slower decline in density compared to the woman’s other breast.
- Cureus: A recent editorial raises the issue of the cancer “miss” rate in dense breasts, which isn’t considered in risk model estimates. The authors suggest, “The stage is set for new MRI screening guidelines, this time based on individualized density levels that predict the potential benefit of MRI, along with risk stratification that optimizes cancer detection rates.” Read, Breast Density Should Play a Greater Role in MRI Screening Guidelines.
U.S. State Insurance Laws & Canada News
U.S. State Insurance Laws
New state insurance laws for expanded and/or no-cost breast imaging have been signed into law in Arizona, Montana, New Mexico, Pennsylvania, Tennessee, and Washington. Please see DBI’s Legislative Info tab for details. Missouri’s bill is on the governor’s desk for consideration and may be next.
Canada
Just Published
British Columbia Medical Journal, article Breast cancer screening in BC: What we should be proud of and how to make it even better, by DBI Medical Advisory Board member Dr. Paula Gordon.
CAMRT Course Listing
DBI’s CME/CE course Dense Breasts and Supplemental Screening is now available through the Canadian Association of Medical Radiation Technologists (CAMRT) Repository, HERE.
Credit information reminder:
- The CAMRT and the Medical Radiation Practice Board of Australia accept Category A continuing education credits to be used toward continuing professional development requirements by medical radiation technologists and medical radiation practitioners.
- The UEMS-EACCME® has mutual recognition agreements with the AMA for e-learning materials. Additionally, the Royal College of Physicians and Surgeons of Canada accepts AMA PRA Category 1 credits earned through self-learning activities to be used for Continuing Professional Development Section 2 credits.
USPSTF, ACR Recommendations, U.S. Insurance Legislation
United States Preventive Services Task Force (USPSTF)
USPSTF updated screening guidelines updates were just published and now include the recommendation that mammography screening in normal risk women occur every other year beginning at 40 (was 50). Unfortunately, for women with dense breasts, the recommendations incorrectly conclude there is “inadequate” evidence to support adding supplemental screening ultrasound or MRI after a mammogram and fail to recognize the important of annual screening.
- See DBI’s Public Position, “The USPSTF Guideline Should Not Apply to Women with Dense Breasts.”
- NEXT WEEK: look for JBI Opinion piece, “USPSTF Guideline Fails to Address Dense Breasts,” which includes a literature review. We will also share DBI comments to the USPSTF.
2023 ACR Screening Recommendations for Women at Higher Risk
New recommendations just published! For women at higher-than-average risk of breast cancer, the ACR recommends annual digital mammography, beginning between ages 25 and 40, and supplemental screening, depending on risk, with breast MRI as the supplemental method of choice. Notably, women with extremely dense breasts are considered to have approximately twice the “average” risk, and for women with dense breasts who desire supplemental screening, breast MRI is recommended.
Federal Bill, the Find It Early Act
The federal insurance bill, the Find It Early Act, has been re-introduced in this session of Congress by Reps. DeLauro and Fitzpatrick. Their announcement HERE.
New U.S. State Insurance Laws
Insurance coverage for breast imaging has been signed into law in:
- Pennsylvania (Act 1 of 2023). The law provides for “all costs associated with one supplemental breast screening every year if a woman is believed to be at an increased risk of breast cancer” due to specified reasons. The law also provides coverage for BRCA-related genetic counseling and genetic testing.
- Maryland (Chapter 0298). The law prohibits, “… except under certain circumstances, insurers, nonprofit health service plans, and health maintenance organizations that provide coverage for diagnostic and supplemental breast examinations from imposing a copayment, coinsurance, or deductible requirement for the examination.”
For more details, please visit the DBI Legislative Information tab.