Breast density legislation linked to improved ultrasound utilization, cancer detection

The passage of breast density notification legislation leads to improvements in ultrasound utilization and cancer detection, according to new findings published by the American Journal of Public Health. The key, the authors found, is for the legislation to specifically emphasize the importance of supplemental screening methods.

Such bills have been passed in more than 30 states, and a federal requirement was even signed into law back in February. The study’s authors examined screening rates and breast cancer care in nine states that enacted breast density notification legislation in 2014 and 2015, comparing the totals with 25 states that did not have a bill in place at that time.

To learn even more about how these laws can impact women’s health, the researchers explored how legislation that specifically mentioned the benefits of supplemental tests compared with legislation that only included information about the patient’s breast tissue.

Overall, the authors found that breast density notification laws that specifically mentioned supplemental screening were associated with 10.5 more ultrasounds and 0.37 breast cancers detected per 1,000 mammograms than states with no legislation at all. “No significant differences” in ultrasound or cancer detection rates were noted between states with traditional breast density notification laws (that don’t specifically mention supplemental screening) and states with no laws at all.

“Our study suggests that if one of the goals of dense breast notification laws is to change clinical practice, the language of the legislation is important,” co-author Susan Busch, MD, department of health policy and management at the Yale School of Public Health in New Haven, Connecticut, said in a prepared statement. “Including specific information about additional testing is more effective than vague recommendations that suggest talking to your doctor.”

Co-author Cary Gross, MD, noted in the same press release that detecting more cancers “does not necessarily translate to patient benefit.”

“Sometimes, performing more screening might simply detect more early-stage cancers that might not have caused a problem,” Gross said. “The key outcome for a screening program is to decrease rates of advanced cancers, and to decrease mortality. We need further study to determine whether these more aggressive screening strategies are actually having a positive impact.”