By JoAnn Pushkin

With Governor McCrory's signature, North Carolina became the 12th state on July 23rd to enact a mandatory breast density inform law (Session Law: 2013-321). Density inform laws require patient notification of breast density in the mammography result "lay" letter, which is sent to women after their mammograms.

Eight months after a "normal" mammogram, North Carolina patient/advocate, Addy Jeffrey, felt a lump in her breast during a self-exam. The mass, found to be an invasive breast cancer almost the length of an iPhone, was estimated to have been growing for at least three years. Like other cancer fighters and survivors across the country, Addy learned about the inherent risks of her dense breast tissue only after her cancer diagnosis.
Though approximately 40 percent of women of mammography age have dense breasts, a 2010 Harris Interactive poll found that 95 percent of women did not know their own breast density. While it is common knowledge among breast imagers that breast density can obscure cancer(s) on a mammogram, this awareness about the limitation of mammography in dense tissue is not shared by women. And beyond density's "masking" effect on a mammogram, breast density has other associated risks. Research indicates the presence of dense breast tissue raises the risk of developing breast cancer: "Breast density in and of itself has been shown by several studies to be an independent risk factor for the development of breast cancer, with the relative risk for women with the most dense breasts 2 to 6 times that of women with the least dense breasts," according to a study in JACR from 2010.

In the absence of a federal standard for density notification, each individually authored state law results in growing inconsistency in breast density inform language. The level of notification is dependent on which state a woman calls home. For instance, women in Maryland receive notification that begins by stating: "If your mammogram shows that your breast tissue is dense you should know...." While women with dense breasts in neighboring Virginia receive unambiguous notification that: "Your mammogram demonstrates that you have dense breast tissue."

Just over 40 percent of U.S. women now live in states with mandatory breast density inform. And, while every state legislative success is welcomed news, the growing number of individual state efforts makes clear the time has come for nationwide standardized notification. Every woman in every state deserves to be equally informed about her own breast density and its inherent risks.

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