Impact of Breast Density Reporting Legislation on Utilization and Outcomes
Description: Supported by patient advocacy groups beginning in 2009, 27 states have passed laws requiring women be notified if they have “mammographically dense breasts” at the time of their screening mammogram. These laws were motivated in part because dense breast tissue may modestly increase breast cancer risk. However, dense breast tissue also makes it more difficult to find breast cancer with mammograms. A few research studies have suggested that having supplemental breast cancer screening tests such as ultrasound may help find breast cancers sooner than screening mammography alone. It is for that reason that many of the density laws also encourage women with dense breasts to obtain supplemental screening tests despite the fact that currently no scientific, professional or governmental organization, including the American Cancer Society, recommends this practice. Of concern is that the additional screening tests may also increase the chance that a woman without breast cancer will undergo potentially unnecessary diagnostic testing procedures such as additional mammograms or breast biopsies. Because approximately 40% of U.S. women have dense breasts, these density notification laws will affect many women. At present, we do not know how breast cancer screening use has changed in response to the laws and more importantly, if and how this has improved women’s health.
Our objective is to compare the rates of breast cancer screening tests and of breast cancer detected over time in the 27 states with the density notification laws to those in the 23 states without similar laws. We will study the use of breast cancer screening and diagnostic tests in a large nationwide commercial insurer from 2001 to 2017 covering over 25 million women aged 25-64. Research questions to be addressed are whether the use of supplemental breast screening and other procedures for screening and diagnosis have been affected by state-specific adoption of density notification laws, who is using supplemental screening, and how these laws have affected existing disparities in use of breast cancer screening. To examine breast cancer detection, we will use cancer registry data from all 50 states from 2001-2017. Pressing questions about rates of breast cancers detected will be examined.
While density notification laws may ultimately improve women’s health, use of unproven supplemental breast cancer screening tests may also result in serious unintended consequences including increased chances of unnecessary diagnostic tests and financial costs. This study will document real-world changes in the benefits and harms resulting from adoption of density notification laws. These findings will serve to guide future density notification policies, both in the remaining 23 states and at the federal level. For women and their doctors, results about the benefits and harms of supplemental screening will provide valuable information for deciding whether to undergo supplemental screening.
Funder: American Cancer Society
Amount: $788,000
Funding type: award
Start date: 2017-07-01
End date: 2017-04-15
Investigator: Natasha Stout
Institution: Harvard Pilgrim Health Care, Inc
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Funded outputs count: 0
Funder award ID: 130322-RSG-17-104-01-CPPB
OpenAlex ID: G3050136592