California breast density law slow to have an impact

Ten months after California legislators enacted a controversial law mandating that radiologists notify women if they have dense breast tissue, researchers have found that half of primary care physicians are still unfamiliar with the law and many do not feel comfortable answering breast density-related questions from patients.

The findings, to be published in the Journal of the American College of Radiology (2015; doi:10.1016/j.jacr.2014.09.042), suggest that if the law is going to have any significant impact on patient care, primary care providers need more education about breast density and secondary imaging options.

"Overall, the impact of the breast density legislation probably is not significant if primary care physicians are not educated or aware of it," said lead author Kathleen Khong, MD, a University of California Davis radiologist and staff physician. "We should put some emphasis on educating primary care physicians so that when they get questions from patients, they can be comfortable in addressing the issues."

The California law, which took effect in April 2013, requires that patients whose breast density is defined as heterogeneously dense or extremely dense (approximately 50% of women), receive notification that dense breasts make it harder to read mammograms.

The researchers point out that breast density has long been a required part of any radiologic report following mammography, but unless a patient asks to see the report, the information is shared only with the patient's providers. Led by patient advocates, the legislation is intended to increase awareness of dense breasts and encourage patients to discuss the clinical issues with their doctors. According to published research, 28 states have passed, rejected, or considered dense-breast notification legislation since 2009.

Though the study demonstrated that women and their doctors are receiving the notifications, many of those physicians are unclear about what to do with the information. As a consequence, the researchers said, it appears that relatively few patients with dense breasts are asking questions about their breast density and its implications.

The UC Davis study surveyed 77 physicians about the new law. Roughly half (49%) reported no knowledge of the legislation and only 32% of respondents noted an increase in patient levels of concern about breast density compared to prior years. In addition, a majority of primary care physicians were only somewhat comfortable (55%) or not comfortable (12%) with breast-density questions from their patients.

Khong said their survey results were surprising, but acknowledged that many primary care physicians may not feel they have sufficient training to make a clinical recommendation for a particular type of secondary screening. In fact, the study also found that 75% of respondents would like more education about the breast-density law and its implications for primary care.

"The law has raised a lot of awareness about breast density," said coauthor Jonathan Hargreaves, MD, also of UC Davis. "That being said, mammography screening is the primary thing patients need to do, and beyond that, the real benefits of other screening techniques are still the subject of ongoing medical debate."

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