Have you ever heard of dense breast? Well if you have not its a condition with that puts women at a high risk of getting cancer. Forty percent of women have dense breast tissue, significantly increasing their risk of cancer. Should states be required to notify them—even if it causes unnecessary anxiety?
By Barbara Feder Ostrov, Kaiser Health News
Earlier this year, Caryn Hoadley received an unexpected letter after a routine mammogram.
The letter said her mammogram was clean but that she has dense breast tissue, which has been linked to higher rates of breast cancer and could make her mammogram harder to read. “I honestly don’t know what to think about the letter,” said Hoadley, 45, who lives in Alameda, California. “What do I do with that information?”
Millions of women like Hoadley may be wondering the same thing. Twenty-one states, including California, have passed laws requiring health facilities to notify women when they have dense breasts. Eleven other states are considering similar laws, and a nationwide version has been introduced in Congress.
Breast cancer is the second-most common form of cancer among American women, behind skin cancers, and the second-leading cause of cancer death. An estimated 231,840 U.S. women will be diagnosed with invasive breast cancer in 2015, according to the American Cancer Society.
About 40 percent of women have dense—or extremely dense—breast tissue, which can obscure cancer that might otherwise be detected on a mammogram. Advocates have hailed the laws as a way to empower women to take charge of their own health. But critics say the laws cause women unnecessary anxiety and can lead to higher costs and treatment that doesn't save lives or otherwise benefit patients.
“While I think the intent of these laws is well meaning, I think their impact is going to be a significant problem, where we end up doing more harm than good,” said Dr. Laura Esserman, a University of California-San Francisco surgeon and breast cancer specialist.
Typically, the laws require a notice be sent to a woman if she has dense breast tissue seen on a mammogram. Some notifications suggest that a woman talk to her doctor about additional screening options.
But in some states the laws go further, requiring health providers to offer a supplemental screening like an ultrasound to women with dense breasts, even if their mammograms are clean. Connecticut, Illinois, and Indiana even require insurers to pay for screening ultrasound after mammography if a woman’s breast density falls above a certain threshold.
Otherwise insurers do not routinely cover supplemental screening for women with clean mammograms, even if they have dense breasts. The Affordable Care Act does not require it.
The problem, Esserman says, is that no medical consensus exists on whether routine supplemental screening for women with dense breasts is worthwhile. A recent Annals of Internal Medicine study using computer modeling found that offering an ultrasound to women with dense breasts after a clean mammogram would not significantly improve breast cancer survival rates but would prompt many unnecessary biopsies and raise health care costs.
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