FDA national “dense breast” reporting standard introduced, more HERE. 

 

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Get Smart About Being Dense

EUROPEAN VISITORS

Screening

2D vs 3D Mammography and More

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New Research
DBI Medical Advisory Board member Dr. Emily Conant is lead author on Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings. The findings indicate that women undergoing digital breast tomosynthesis had higher cancer detection rates, higher positive predictive value, and lower recall rates compared with women who underwent digital mammography. Consistent with other studies, the study found improved cancer detection rates for women with heterogeneously or extremely dense breasts using 3D.  Recall rates were reduced in heterogeneously dense breasts but not in extremely dense.

Europe
DBI’s European Education Coordinator Cheryl Cruwys has been active educating on the implications of dense tissue and sharing DenseBreast-info.org/Europe resources:

Federal Legislation, New Publication

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Want to get involved?  Check the Find It Early Act webpage for information on how to contact a congressperson, how to schedule a meeting, what to bring, what to ask, and follow up suggestions. This “Lobbying 101” page was developed with feedback from Rep. Rosa DeLauro’s office on best practices and input from our Patient Advisory Group on language.

Newly Published
Out in Radiology, Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis with accompanying editorial by MAB member Dr Regina Hooley. In a meta-analysis of 3D mammography, ultrasound, or MRI to supplement 2D mammography, Hussein et al report results consistent with the literature that screening MRI outperforms anatomic imaging in cancer detection. MRI found 26 cancers per 1000 women screened, with acceptable PPV of biopsy.  Not all women can tolerate MRI, however, and, in their analysis, supplemental screening with either handheld or automated US found 4 cancers per 1000 women screened that were missed on mammography.

Updates in the U.S. and Europe

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U.S. State Density Inform Bill and Insurance Bills
West Virginia has introduced two density “inform” bills; please see DBI’s updated legislation MAP for details. And, insurance bill introductions requiring coverage for expanded breast imaging continue with 20+ bills so far!

Europe: Screening Guidelines
Greece now has a national (organized) screening program. Please find updated information by country in our European Screening Guidelines MAP and TABLE.

Provider Education

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Educating Providers in Related Disciplines
A concise presentation by Dr. Wendie Berg, Breast Density Notification Rule: 2022 FDA, just aired on Oncology Tube. Topics included the implications of dense tissue, details on supplemental screening options, and the upcoming FDA national reporting standard.

National Rad Tech Week
This week was National Rad Tech Week in the U.S.  DB-i highlighted the day by sharing a fan-favorite YouTube video of mammographer Cindy Staker discussing the importance of positioning and the role technologists play in cancer detection. if you haven’t seen this powerful short video, it’s worth the watch/share, here.

Latest Updates and News at DB-i

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Updated Table:
As new research is published, website content is reviewed to incorporate it. Newly updated is the popular Technology Tab table, Cancer Detection by Screening Method.

DB-i in the News:
Breast Cancer Awareness Month and news of an updated FDA timeline for a U.S. national “dense breast” reporting standard resulted in much demand for DB-i comments, story input, and images. Below are some national media opportunities we were included in:

Women Can Handle the Truth

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Australia:
The Medical Journal of Australia interviewed DB-i’s Dr. Wendie Berg and JoAnn Pushkin about density notification and supplemental screening. Their position is that “Not notifying women about their dense breasts robs them of the opportunity to seek supplemental breast cancer screening and the chance to catch a cancer as early as possible.” The interview is available in podcast and article format:

Canadian Breast Screening Guidelines:

Technology and Spanish Updates

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Updated Technology Tab Table:
As part of our ongoing review, the popular Technology Tab table, Cancer Detection by Screening Method has just been updated. It complements the recently updated simplified patient Q+A table, If I have dense breasts and cancer might be missed on my mammogram, what else can I do?

Spanish Fact Sheet:
Hispanic people are the largest minority (62+ million) in the U.S. and make up the 13.5% of the U.S. population that speak Spanish at home. To address the educational needs of this community, DB-i features a full suite of content in Spanish. Among patient Spanish-language tools is the just updated printable Spanish Patient Fact Sheet.

Canadian Screening Outcomes Call into Question Current Canadian Task Force Guidelines

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 A study co-authored by DB-i Medical Advisory Board member Dr. Seely just out: The Impact of Organised Screening Programs on Breast Cancer Stage at Diagnosis for Canadian Women Aged 40-40 and 50-59.  In 2011, the guidelines changed from those in 2001 which stated, “Upon reaching the age of 40 Canadian women should be informed of the potential benefits and risks of screening mammography and assisted in deciding at what age they wish to initiate the manoeuvre” to 2011 Canadian Task Force guidelines, ”For women aged 40–49 years, we recommend not routinely screening with mammography.”  As a result, only 4 provincial screening programs in Canada currently allow women to self-refer for mammography starting at age 40.

The study evaluated changes in the incidence of breast cancer by stage from 2011 to 2017. Due to reduced mammographic screening for women in their 40s, over the 6 years of the study, the authors found:

  1. Women in their 40s had a 13.6% decrease in incidence of stage I and a significant 12.6% increase in stage II disease.
  2. For women in their 50s, the incidence of stage II disease increased by 3.1%
  3. In provinces that did not continue to have organised screening programs for women 40-49, there was a 10.3% increase in stage IV breast cancer in women 50-59 over the six years.

The findings support the recently updated National Comprehensive Cancer Network guidelines that recommend annual screening mammography for average-risk women beginning at age 40.

Patient Advisory Group (PAG) Launched

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As it is important that patients have a voice at the table about the DB-i website, we have launched a PAG. Our PAG members provide their unique perspective on website content needs, understandability, and user experience. Notably, each PAG member contacted us after visiting the website as they were impressed with the depth and breadth of content. The PAG has been instrumental in content review as part of our health literacy project. Please see our Press Release about this DB-i initiative.

This ongoing effort will ensure that health professionals can feel confident about the relevancy and useability of the DB-i website as an educational resource for patients. 

New U.S. Federal Law
The Making Advances in Mammography and Medical Options for Veterans Act (Public Law 117-135) tasks the Secretary of Veterans Affairs with developing a strategic plan for improving breast imaging services for veterans including the evolving needs of women veterans, geographic disparities of breast imaging, and the use of 3D tomosynthesis.

Health Care FAQ Update

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We have received queries from health professionals in the U.S. about how to write an order for supplemental screening. With the input of our Medical Advisory Board, we have reviewed and updated FAQ #26 “If my dense-breasted patient would like supplemental screening after her mammogram, how should I write the order?”

The full list of 50+ Health Provider FAQs can be accessed here (and for our EU colleagues, here).

As a reminder, comprehensive lists of Patient Q+As are available in website sections:

  1. DB-i/Home
  2. DB-i/Europe
  3. DB-i/Spanish

New U.S. State Law & More

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The state of Ohio has a new law which requires (1) updated and more comprehensive density “inform” notification to patients and, (2) new expanded insurance coverage for breast imaging (both effective 9/23/2022). Please visit our MAP or TABLE for more information.

Newly Published
Original research just published in the Journal of Breast Imaging, Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment. The findings show that breast imaging facilities in states with breast density inform laws often offer supplemental screening compared to facilities in states without “inform” laws. Further, a statistically significant proportion of facilities in non-inform states had no supplemental screening nor plans for implementation.

Resource Updates and Extended Outreach

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Who Needs More Screening? Flowchart:
The Who Needs More Screening? flowchart has been newly updated to reflect NCCN endorsement of contrast-enhanced mammography or ultrasound for women who meet criteria for screening MRI but are unable to have it; please discontinue use of any earlier version.  (European visitor access: click USA/HOME, and see dropdown in For Providers tab)

Density Education in Europe:
The European Federation of Radiographer Societies (EFRS) will be linking to DB-i website/materials as a resource for their members. Through its member organisations, the EFRS represents 45 national societies/professional bodies, 66 academic institutions of radiography education, and more than 105,000 radiographers and 8,500 radiography students across Europe.

The International Cancer Control Partnership (ICCP) now includes the DB-i link within the ICCP resource portal of key resources. The ICCP is a group of organisations engaged in supporting country cancer control planning efforts. Through the ICCP, these organisations, including the WHO, CDC, NCI-USA, and UICC, are committed to working together to ensure that all countries have a well-resourced, quality cancer control plan, integrated with non-communicable disease control efforts.

RSNA:
It is the time of year when many are normally headed to RSNA.  While always a wonderful opportunity to meet with our generous Educational Supporters and host DB-i’s annual MAB and European Ambassadors appreciation dinner, this year will be quite different. We wish all a productive virtual RSNA and look forward to seeing everyone in 2021!

Who Needs More Screening? UPDATE

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NEWS:  Who Needs More Screening? flowchart update

  • Our hard-working Medical Advisory Board has updated one of DenseBreast-info.org’s most frequently referenced tools. The  Who Needs More Screening? flowchart* has been updated to include risk assessment by age 30 and expanded the indications for supplemental MRI. It takes into consideration updates to NCCN guidelines and the recent publications from the DENSE trial and EA1141 (Comparison of Abbreviated Breast MRI and Digital Breast Tomosynthesis in Breast Cancer Screening in Women with Dense Breasts).
  • For those referencing or sharing the flowchart, please discontinue use of any prior version. Please contact us for direction on the update.

*European visitors, to access from DB-i/EU homepage, select Home/USA, then “For Health Professionals, tab” and then “Flow Chart” in the dropdown menu. An update to the EU screening flowchart will follow. 

COVID and Screening

New Opportunities for Engagement on Breast Density

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#DenseBreastDay™
The Sept 30th online education day, organized in conjunction with Yale Medicine, resulted in “likes”, shares and comments from patients, health providers and health organizations from across the globe. DB-i website visits exceeded 1,000 for the day.  Many thanks to our corporate Educational Supporters for their participation. We are still compiling social media analytics, stay tuned!

Australia: Density Inform and Education
A new patient video produced by InforMD, an alliance of Australian breast cancer researchers advancing knowledge on breast density, has been launched: https://www.youtube.com/watch?v=EZHjEFGEtaA

Diversity in Screening Implications
A new webinar from the Hawaii Radiological Society and an article published in the Journal of Breast Imaging are just out on the topic:

New Study in Radiology on Supplemental Screening

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New Study
In a recent publication in Radiology, researchers from the Karolinska Institutet in Sweden used AI to analyze breast density, presence of masses and calcifications, and differences between right and left breasts to successfully predict women who would develop interval cancer or advanced cancer in the two years after a normal mammogram; their model proved more accurate than traditional risk models and can augment genetic/family history to help identify women who should and, importantly, who should not have supplemental screening after 2D mammography.

Breast Cancer Awareness Month Reminders
In support of #BCAM, DB-i has launched an education initiative for both the patient and health provider communities:

#DenseBreastDay™ is this Wednesday, Sept 30th. It will be a full day social media blitz for the general public hosted in conjunction with Yale Medicine. Educational tweets will be posted every half hour, please share! Europe-specific content tweets and posts in Spanish are included in the day’s schedule.

New Research On Mammography Screening

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New Research:
Age 40 or 50? A randomized, controlled trial at 23 breast screening units in Great Britain aimed to estimate the effect of mammographic screening at ages 40-48 on breast cancer mortality. The findings have just been published in The Lancet/Oncology: Effect of mammographic screening from age 40 years on breast cancer mortality: final results of a randomized, controlled trial.

DenseBreast-info.org Content:
Did you know we have made over 200 updates to DB-i website content so far this year? These include our updated and expanded table, Summary of Cancer Detection Rates by Screening Methods (European visitors, click HERE). It is a popular resource and compares, by modality and breast density category, the added cancer detection rate, the impact on false positive rate, and details the types of cancers seen.

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