WSRS BITF Breast Density Notification Guide

Purpose of This Website:

This website was created by the Washington State Radiological Society Breast Imaging Task Force and other medical providers. The goal of this website is to help patients, technologists, radiologists and other medical providers understand the legislation and provide answers to the most common questions and guidance for subsequent decisions about medical care related to screening for breast cancer.

Content of This Website:

The website is organized by to provide answers to frequently asked questions from patients, technologists, radiologists and non-radiologist providers. The site also includes additional information about breast cancer risk and risk reduction. We invite your comments and feedback.

Why Was This Website Created in 2018:

The Washington State legislature passed a bill regarding “Breast Health Information – Mammography” for patients. The new law becomes effective January 1, 2019 and requires mammography facilities to include specific language in the letters that are sent directly to patients with their results. The goal of the legislation is to inform patients if they have dense breast tissue so they have the opportunity to make personal decisions about their health care.

Patients with dense breast tissue will receive the following text in a letter with their mammogram results:

“Your mammogram indicates that you may have dense breast tissue. Roughly half of all women have dense breast tissue which is normal. Dense breast tissue may make it more difficult to evaluate your mammogram. We are sharing this information with you and your health care provider to help raise your awareness of breast density. We encourage you to talk with your health care provider about this and other breast cancer risk factors. Together, you can decide which screening options are right for you.”

SBI Recommendations for a Thoughtful Return to Caring for Patients

The Breast Imaging Task Force of the WSRS fully endorses the recent statement put forth by the Society of Breast Imaging which outlines a thoughtful and sensible approach to re-opening of breast imaging services during these uncertain times. We strongly encourage anyone considering this to read the “SBI Recommendations for a Thoughtful Return to Caring for Patients.” We also strongly recommended adhering to evolving guidelines issued by State Government to protect patients and healthcare providers from coronavirus infection.

COVID-19 Radiology-Specific Resources

The WSRS Breast Imaging Task Force fully supports the information and suggestions recently put forth by the ACR aimed at reducing the impact of COVID-19. Given the rapidly unfolding situation in our state, the BITF recommends that breast imaging centers consider temporarily suspending routine screening mammography services as we gain a better understanding of the impact of COVID-19 on our region.  If centers choose to continue routine screening, we recommend that patients be given the opportunity to  reschedule their exam for a later date.

3D Mammography in the News

The Seattle Times published a front-page article on Oct. 27 about 3D mammography. This piece, which was published in USA Today last week, stated that digital breast tomosynthesis (DBT or 3D mammography) was no better than 2D. This is simply not true. Since you or your fellow team members might receive related questions from patients, we wanted to provide you with talking points about the benefits of 3D mammography.

They include:

  • The Seattle Times article refers to a study published in 2019, which found more cancers in patients getting 3D mammography, but not enough to reach ‘statistical significance.’ Although this Norwegian study involved 30,000 patients, results from a similar study published in The Journal of the American Medical Association (JAMA) in 2014 (Friedewald) looked at 450,000 patients and found a significant increase in cancer detection (29 percent) among Americans who were studied. If the Norwegian study had been larger, it may have reached the same statistical significance.
  • While cancer detection is the reason for screening, it is not the only goal. The Norwegian study confirmed that 3D mammography lowers recall or false-positive rates. In that study, rates dropped 22.5 percent. That is significant for patients and groups that cite false positives as a major risk of screening. The 2014 JAMA study also reported a 15 percent decrease in recall – which saves money, time, radiation and anxiety.
  • Fewer false positives lead to a significantly better positive predictive value (PPV) for 3D compared to 2D mammography. That is also in the Norwegian study, but not mentioned in the article. Again, this saves money, time, radiation and anxiety for patients and the health care industry.
  • Other peer-reviewed articles not mentioned in the article have shown the simultaneous increase in cancer detection and decrease in false positives. (Skaane, Rafferty, etc.).
  • Lastly, the WSRS does not have any industry related relationships that would bias this recommendation.

ACR Breast Imaging Toolkit

“Talking to Patients about Breast Cancer Screening” CME Toolkit from ACR

The ACR strongly encourages radiologists to download these materials now available on their website. This toolkit contains informative materials designed to better inform patients and help providers assess the breast cancer screening needs of their patients.

  • Customize them with your branding
  • Share with your referring clinicians and advise them of CME availability!
  • Place patient materials on your website and in your waiting room
  • Print and include in correspondence with patients and referring providers
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