ASPO Abstracts
Determining the Impact of Breast Density Legislation on the Use of Supplemental Screening in North Carolina
Category: Early Detection & Risk Prediction, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
Purpose. Mammographic breast density is a known risk factor for breast cancer and makes cancer detection more difficult. Currently, 30 states have breast density notification laws. Effective January 2014, breast imaging facilities in North Carolina (NC) are legally required to notify women of their breast density and its potential impact. We examined whether the NC breast density notification law resulted in increased supplemental screening use or a change in the type of screening women received. Methods. We studied Carolina Mammography Registry participants aged 40-79 years who received a 2D digital screening mammogram from January 2013-July 2016 with a negative or benign Breast Imaging Reporting and Data System (BIRADS) assessment. Breast density was dichotomized as dense (extremely dense or heterogeneously dense) and non-dense (scattered fibroglandular density or almost entirely fatty). We defined supplemental screening as receipt of digital breast tomosynthesis (DBT), ultrasound, or MRI performed within 3 months of the 2D digital screening mammogram with no symptoms of breast cancer. Screening mammograms from 2013 were classified as pre-law and those in 2014 or later as post-law. Using chi-square tests, we examined differences in the proportion of women with dense vs. non-dense breasts who received supplemental screening pre- and post-law. We also evaluated whether women with dense vs. non-dense breasts were more likely to use DBT for screening after passage of the density law. Results. We included 96,739 screening mammograms performed at 12 community breast imaging facilities. A similar proportion of women had dense breasts in the pre- and post-law era (30% vs. 29%, respectively). The proportion of women who received supplemental screening pre- and post-law was <1% for both density groups and did not differ when the supplemental screening window was extended to 6 or 9 months. Similar proportions of women with dense and non-dense breasts switched to DBT for screening in the post-law era (12.6% vs. 12.5%, respectively). Conclusions. Breast density notification in mammography result letters did not influence the receipt of supplemental screening in NC. Breast density also did not appear to play a role in changing screening behavior from 2D digital to DBT.
Keywords: mammography; screening; breast density