There has been a lot of celebrity news this week around risk assessment and models. We’d like to remind you that DBI features a Risk Model Tutorial; click the link for details on how the models are used, risk model explanations, diagnostic considerations, and for a Risk Models Table with live links to the models.
Blog
Updated FAQs
Does estrogen or HRT affect breast density or breast cancer risk? This is a common question and we have conducted a literature review. Please see DBI’s updated Patient and Health Providers FAQs on the topics:
For Patients
- Does taking estrogen increase breast density or breast cancer risk?
- Does taking hormone replacement therapy (HRT) treatment increase breast density or breast cancer risk?
For Providers
New State Inform Law, ESR Gold Medal Recipient
U.S. State Inform Law
Better late than never! Indiana has enacted a breast density inform law (effective July 1, 2024) which mirrors the new FDA required “dense breast” reporting language (effective Sept 10, 2024). This brings the number of states with inform laws to 39 and the District of Columbia. Please see DBI’s legislation MAP or TABLE for more details.
European Congress of Radiology – Highlight
Congratulations to Prof. Boris Brkljačić, Chair of the EuroSafe Imaging Steering Committee and DenseBreast-info.org/Europe Education Supporter! Prof. Brkljačić was awarded the ESR Gold Medal, the highest honour bestowed by the society, at the ECR 2024 Opening Ceremony.
New Insurance Bill, State vs FDA “Inform” Requirements
U.S. State Insurance Bill Update
Massachusetts has become the latest state to introduce an insurance bill for expanded breast imaging beyond a mammogram.
State “Inform” Laws and the FDA Reporting Standard
We have received questions about existing state dense breast inform laws and the imminent FDA dense breast reporting standard. It is important to note that 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in addition to the FDA requirement unless that state law specifically defaults to the new FDA standard, expires, or is repealed. FDA guidance is that mammography facilities should be aware of and comply with all applicable local, state, and federal “dense breast” reporting requirements. More information, including how to contact the FDA with questions, is available here.
ECR Meeting, New MAB Member
European Congress of Radiology
DenseBreast-info.org/Europe will be attending #ECR2024, (Feb 28 – March 3) in Vienna. Both DBI’s European Liaison Dr. Athina Vourtsis, and Education Coordinator Cheryl Cruwys, will be on hand. Please visit the DBI/Europe team in the Austria Center, Level 1, Foyer 1, at the ESR Patient Advisory Group booth.
Medical Advisory Board
Please join us in welcoming Dr. Ellen Mendelson to DBI’s stellar Medical Advisory Board! Dr. Mendelson is Professor Emeritus of Radiology and formerly Division Chief of Breast and Women’s Imaging at Northwestern University Feinberg School of Medicine in Chicago, IL. Her extensive clinical research includes authorship and co-authorship of over 34 peer reviewed articles and participation in 2 clinical trials in the past 15 years. Dr. Mendelson’s long-awaited textbook on automated breast ultrasound is scheduled for publication in late 2024, (Mendelson, Vourtsis, and Spear, eds. Automated Breast Ultrasound for Screening and Diagnosis, Elsevier).
Updated Technology Tab Info, New Co-Educator
Screening Technologies Update
DBI’s Screening Technologies tab has just been updated! For easy reference, each updated modality section now includes “Quick Facts” bullets in the introduction. Many thanks to our hard-working Medical Advisory Board for their editorial input.
Coming soon: The new FDA dense breast reporting standard goes into effect in September and will result in new patient/provider conversations about supplemental screening. To help inform patients about supplemental screening options, DBI will be launching a dedicated patient-friendly screening technology section. Stay tuned!
New Education Co-Educator
Service Women’s Action Network (SWAN) is “the voice of all military women” including the 350,000 active service women and 2 million women veterans in the U.S. We welcome SWAN to our Education Coalition and are honored the organization now includes DBI as a resource for members: https://www.servicewomensactionnetwork.org/obgyn
New Insurance Bills, The Patient’s Perspective
U.S. Insurance bills
New insurance bills for coverage of expanded breast imaging have been introduced in the states of Iowa and Oklahoma.
SBI Newsletter
SBI’s Winter 2024 newsletter includes an interview with DBI’s JoAnn Pushkin, in The Patient’s Perspective column, about the patient dense breast experience, advocacy efforts and next steps on the legislative front.
JBI Open Access Article, UK Celebrity Supporter
JBI Article – Now Open Access
Article Implementing the National Dense Breast Reporting Standard, Expanding Supplemental Screening Using Current Guidelines, and the Proposed Find It Early Act is now available as open access. The FDA’s density reporting requirement goes into effect on September 10, 2024. Letters will tell women if their breasts are “dense” or “not dense.” Implementing appropriate supplemental screening should be based on patient risk for missed breast cancer on mammography; such assessment should include consideration of breast density and other risk factors. Many women with dense breasts meet current criteria for “high-risk” screening and should be recommended for screening MRI. This article discusses strategies for implementation and simple “back-of-the-envelope” guides to help identify women at high risk. Please share the article with colleagues and on social media.
UK News – Celebrity Supporter
In a national UK TV appearance, Julia Bradbury, TV presenter/journalist/celebrity, talked about her dense breasts and missed-cancer-on-a-mammogram experience: https://x.com/5_News/status/1747700392345862533?s=20. Julia’s social media posts that followed directed viewers to DenseBreast-info.org/Europe and resulted in an amazing response! Over 121.8K views, 9,404 likes and 1,026 comments. About 100 women contacted Cheryl Cruwys, DBI’s European Education Coordinator, for more information. We thank Julia, who is passionate about raising dense breast awareness!
U.S. State Insurance Bills
We are off to a strong legislative start to 2024! 2023 bills that are still active and 2024 newly introduced bills for expanded breast imaging coverage (see bill texts for details) include:
CME/CE Free Credit Opportunity
Need credits? Snow problem! Please visit/share the winter promotion for our course Dense Breasts and Supplemental Screening. Free AMA (1.5 PRA Cat 1) and ASRT (1.5 Cat A) credits* are available for this comprehensive learning opportunity.
*The UEMS-EACCME® has mutual recognition agreements with the AMA for e-learning materials. 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.
*The Canadian Association of Medical Radiation Technologists 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.
Australia/New Zealand News
Australia and New Zealand
The Royal Australian and New Zealand College of Radiologists have issued a Breast Density Position Statement, “Whilst a future risk-based model for breast cancer screening is being developed, RANZCR recommends mandating the reporting of breast density in both screening and diagnostic settings in Australia and New Zealand.”
National density reporting efforts elsewhere include:
- U.S.A. – The FDA’s national dense breast reporting requirement goes into effect September 10, 2024.
- Europe – The European Society of Breast Imaging (EUSOBI) issued recommendations in 2022 that 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
- Canada – According to DenseBreastsCanada, 8 provinces require density inform and 3 more are currently finalizing implementation (which will be 11 out of 12 Canadian jurisdictions).
New Year, New Laws
U.S. State Insurance Laws
The DBI legislation maps have been updated! There are now 25 states + DC that require some level of supplemental screening coverage after mammography. Please see resources:
- Full map (state inform/insurance laws, image + details)
- Insurance law map (image only)
What a Year!
Medically sourced information on dense breasts is a needed resource. DBI hosted 810,000 website visits in 2023! In 2024, we expect to exceed 1 million visitors.
News out of Canada, Research
Dense Breasts Canada
Our friends at Dense Breasts Canada have provided an update on Federal and Provincial advocacy progress in 2023. Find it all HERE.
New Research
A new study is just out in The Lancet/Europe, European validation of an image-derived AI-based short-term risk model for individualized breast cancer screening—a nested case-control study. Two-year absolute risks of breast cancer were predicted at study entry and assessed after two years of follow-up. The study showed that AI can identify women at high risk of developing breast cancer who may benefit from supplemental screening. The model is effective in women with both non-dense and dense breasts.
NCCN Guideline Update, New Research
NCCN Guidelines, Version 3.2023
The most recent National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnosis guidelines are out (accessible with free registration). The “Screening or Symptom Category” guidance on screening average-risk women aged 40+ with dense breasts states, “Consider supplemental screening for those with heterogeneous or extremely dense breasts (BSCR-A)” The BSCR-A excerpt is below for these individuals and high-risk individuals.
Research
Out in JAMANetwork Open, results of a telephone survey in Sociodemographic Variations in Women’s Reports of Discussions With Clinicians About Breast Density. Only 33% of women reported having had a discussion with their provider about breast density. The good news is that of those surveyed, most women indicated their providers asked questions about breast cancer risk, discussed mammography results, and answered questions about breast density. The content of these discussions varied by race/ethnicity and literacy level, with questions about breast density less often addressed in Asian or Hispanic women, and concerns less often addressed among women of lower literacy.
As a reminder, to assist patient education in non-English speakers, DBI has developed:
Statement of Support for Find It Early Act
DBI developed a Statement of Support for this important legislation and worked to get American Alliances, Associations, Colleges, Institutions, Cancer Centers, Imaging Centers, Societies, and Foundations to add their names. Over 40 fellow organizations did so. The bill sponsors, Representatives Rosa DeLauro (D-CT) and Brian Fitzpatrick (R-PA), plan to share this statement with congressional leadership.
The Statement of Support complements other DBI tools created to support the Find It Early Act:
- Fact Sheet
- Lobbying information (how to contact a congressperson and what to ask)
DBI has been at the forefront of efforts for both a U.S. national density reporting standard and for legislation that ensures expanded insurance coverage of breast imaging. We extend thanks to all who support our Education Coalition!
New Studies of Interest
- A population-based study published in JAMA, Breast Cancer Incidence After a False-Positive Mammography Result, found that breast cancer risk within 20 years of a screening mammogram was higher in women who received a false-positive mammogram result than in those who did not. The associated risk was higher among women aged 60-75 years, those without dense breasts, and those who had a biopsy. “This study suggests that breast cancer awareness should be emphasized long term for women with a false-positive mammography result; developing personalized surveillance programs can be beneficial for these women.”
- Just out in Radiology, Impact of Artificial Intelligence–driven Quality Improvement Software on Mammography Technical Repeat and Recall Rates.Summary, “Implementation of artificial intelligence software facilitated largescale mammographic image quality (IQ) evaluation and feedback, resulting in significant improvements in objectively measured IQ and fewer technical repeat and recall images.