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Are women at low risk undergoing unneeded imaging due to dense breasts?

by John W. Mitchell , Senior Correspondent
With 34 states now enforcing laws requiring various notification and supplemental screenings for dense breasts, supplemental breast screenings have seen a five-fold jump. A just-published study found that many women who are at low risk are being referred for the additional imaging due to protocols around dense breast findings, especially among African American women.

“Whereas African American rates were lower before adoption of the law, their rates were equivalent with those of European-American women following adoption of the law," Mark Manning, Ph.D., assistant professor, Population Studies and Disparities Program, Karmanos Cancer Institute, Wayne State University School of Medicine and lead author told HCB News. "At first, we were heartened by these equal rates, until we saw that after the notification law there was no association between breast cancer risk and supplemental screening for African American women.”

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He explained that in European-American women, those who were supplementally screened were at lower risk than those who weren’t. This is the opposite of what the study team expected given supplemental screening guidelines. In short, the findings suggest an adverse outcome of the notification laws. Referrals, they found, veered away from generally accepted breast cancer screening guidelines, and toward unsupported overuse of supplemental screening.

“The results suggest that somewhere in the decision-making process, where there ought to be a consideration of individual breast cancer risk when making decisions about supplemental screening for women who received breast density notification, that consideration is not taking place or being eclipsed by other considerations that we did not capture with these data,” said Manning.

The study, which was published in the recent issue of the Journal of the American College of Radiology, observed that after the notification law, more African American women with dense breasts were supplementally screened. However, it was not because they were at higher risk. The team suspects that this may be because physicians were less likely to discuss breast density and associated risks or to refer appropriate African American women with dense breast before the notification laws went into effect.

Manning said because the study sample came from a subset of women, the study bears replicating with a larger cohort.

“We need to find ways to ensure that density notifications do not further exacerbate disparities in breast cancer mortality, and seek ways that can use them as a means to communicate with women about their breast health,” said Manning.

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(19)

(2)

Steve Arey

Women at low risk for breast cancer undergoing unneeded imaging

November 04, 2018 10:10

So are you going to follow up with the physicians who referred?

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(4)

John W. Mitchell

re: Women at low risk for breast cancer undergoing unneeded imaging

November 05, 2018 06:48

Hi Steve - I have forwarded your questions to the study author cited in the post.

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(4)

John W. Mitchell

re: Women at low risk for breast cancer undergoing unneeded imaging

November 05, 2018 06:48

Hi Steve. Dr. Manning replies: Our view is that providers should use the notification as a means to facilitate women learning about their breast cancer risk, whether it be informally through one of the online breast cancer risk calculators (the National Cancer Institute and the Breast Cancer Surveillance Consortium both have well validated online calculators), or via breast health experts/genetic counselors. Placing the notification, and women's dense breasts, in a more holistic context of their other breast cancer risk factors would be optimal for decision-making around screening.

I have always liked the website http://www.midensebreasts.org/.

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(19)

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Steve Arey

Women at low risk for breast cancer undergoing unneeded imaging

November 04, 2018 10:10

Can we see and read the "law" that you refer to?

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