Has Breast Density Legislation Had Any Impact on Breast Cancer Diagnosis?
BACKGROUND AND PURPOSE:
43 % of women have dense breasts which confers increased risk for breast cancer and reduces screening performance of mammography
Supplemental screening with ultrasound or MRI has poor predictive value
USPSTF (2016) recommends against supplemental screening due to lack of evidence of clinical benefit (decreased morbidity or mortality)
28 states have mandated physicians to inform patients of a finding of dense breasts
Some states require patients be informed of option of potential benefit of supplemental screening
Some states require private insurers to cover costs of supplemental screening
Richman et al. (Journal of General Internal Medicine, 2017) evaluated impact of these laws on breast cancer outcomes based on changes in breast cancer stage at diagnosis after enactment of breast density notification legislation
Population cohort study
Compared Connecticut, the first state to enact notification legislation, to states without such legislation to determine differences in stage of breast cancer at detection
Evaluated changes in stage-specific incidence pre and post legislation to look for a reduction in late stage breast cancers
Data was collected from the Surveillance, Epidemiology, and End Results (SEER) registry
Final analysis included 466,930 women with a breast cancer diagnosis
25,592 lived in Connecticut
Legislation was associated with
1.38-percentage-point increase in proportion of women with localized invasive cancer at the time of diagnosis
1.12-percent-point decline in proportion of women with ductal carcinoma in situ at diagnosis
Legislation was not associated with a change in the proportion of women in Connecticut versus control states with regional-stage or metastatic disease
Whether this increase in localized breast cancer diagnoses is reflective of correct early detection or overdiagnosis remains unclear
Researchers looked at the data by county to see if there was a relationship between increased early detection and decreased metastatic disease and could find no such association, suggesting these additional cases may be overdiagnosis
However, may be underpowered and 4 year follow up may be insufficient to draw conclusions of benefit vs overdiagnosis
Legislation was not associated with a change in any other regional or metastatic diagnosis
Further study required to determine if there is any benefit to notification and supplemental screening for dense breasts
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