A breast tissue screening bill was recently passed by the California Legislature. The focus of the bill is a mandate that physicians must alert patients who have dense breast tissue that their mammograms may fail to reveal a hidden breast cancer. Physicians are fighting the breast tissue screening bill stating that such a measure would cause unnecessary anxiety and place a financial hardship on the medical system and the patients.
Breast Tissue Screening Bill
The origin of Senate Bill 791: Comprehensive Breast Tissue Screening 2011 (previously known as Senate Bill 173), was due to a late stage breast cancer diagnosis of Amy Colton, a registered nurse who faithfully had routine mammograms performed beginning at age 40. Over the past several years she was told that her mammograms showed negative for breast cancer.
After a recent physical revealed her late stage breast cancer, she was told that her previous mammograms had failed to reveal any tumors because her breast tissue was thick and had hid her developing tumors. She later learned that her physician and radiologist both knew that she had extremely dense breast tissue that could interfere with mammogram testing, but they never told her about her breast’s condition and the risk dense breast tissue carries for cancer. Amy Colton stated that, “I’m the patient, it’s my body. But I was never informed.”
Soon afterward, Amy went to the office of Senator Joe Simitian D-Palo Alto, who then began lobbying for a Bill that would require medical doctors to alert their patients who have dense breast tissue.
According to the Bill, “A health care practitioner who performs a mammography examination pursuant to Section 1367.65 of the Health and Safety Code or Section 10123.81 of the Insurance Code shall, if a patient has heterogeneously dense breasts or extremely dense breasts based on the Breast Imaging Reporting and Data System established by the American College of Radiology, include in the summary of the written report sent to the patient, as required by federal law, the following notice: ‘Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office and you should contact your physician if you have any questions or concerns about this report.’”
While many supporters see this as an important Bill toward women’s healthcare, many from the medical field have lobbied aggressively against such a law. Their primary complaint is that such a Bill passed as law would not impact women’s health positively; but rather, would cause undue anxiety and financial hardship as well as bog down physicians and the medical system with excessive demands by women wanting expensive ultrasound and MRI testing beyond a mammogram. Approximately 40% of women meet the criteria of possessing dense breast tissue.
Dense Breast Tissue Support
In spite of arguments against the Bill, health providers do admit that having dense breast tissue is a risk factor associated with breast cancer. From Senator Simitian’s office, a website with frequently asked questions, information, and professional opinions about dense breasts and the risk of cancer to women lists the following quotes acknowledging that dense breast tissue is a serious risk factor that should include testing beyond a mammogram:
• “The main cause of false-negative results [in screening mammograms] is high breast density.” – National Cancer Institute, Fact Sheet – Mammograms, 2010.
• “Breast cancer screening is notoriously imperfect: Breast density … can determine whether or not a mammogram picks up a cancer at all.” – The San Francisco Chronicle, “Mammograms: Risk of Caution,” November 20, 2009.
• “It is critical to understand that the sensitivity of mammography for detecting cancer is lower in dense breasts.” – Journal of the National Comprehensive Cancer Network, Volume 8, Number 10, October 2010.
• “Mammography is not well suited for women with dense breasts” – Journal of Integrative Cancer Therapies, Volume 8, Number 1, September 2009.
• “Breast density is consistently associated with breast cancer risk, more strongly than most other risk factors for this disease, and extensive breast density may account for a substantial fraction of breast cancer.” – Journal of the National Cancer Institute, Volume 102, Issue 16, August 2010.
• “Mammography and US [ultrasound] together had significantly higher sensitivity (97%) than did mammography.” – Journal of Radiology, Volume 225, Issue 1, October 2002.
• “[Ultrasound] with mammography is significantly better than mammography alone for detecting breast cancer, especially for dense-breasted women.” – Journal of European Radiology, Volume 20, Number 3, March, 2010.
In the July issue (2011) of the Journal of the National Cancer Institute in an article titled “Breast Density Tied to Specific Types of Breast Cancer,” researchers concluded that women with breasts that appear dense on mammograms are at a higher risk of breast cancer. And furthermore, that their tumors are more likely to have certain aggressive characteristics than women with less dense breasts.
The controversy of Senate Bill 791 brings to light two points: The first is that a mammogram as a sole diagnostic tool is insufficient toward protecting 40% of the women in the United States. Science needs to come up with better and affordable diagnostic tools.
The second point is that it is evident that the medical field continues to foster a paternalistic attitude toward women’s rights and their need to know. Yes, information can cause anxiety, but is that necessarily a bad thing? Information can also relieve anxiety and lead to positive results. To withhold information from a patient and charge them for a test that may not be doing what the patient is led to believe is unconscionable. Perhaps that is the real hidden cancer.
Senate Bill 179: http://www.senatorsimitian.com/entry/sb_791_comprehensive_breast_tissue_screening/
Breast Density Tied to Specific Types of Breast Cancer JNCI J Natl Cancer Inst (2011) 103 (15): NP. doi: 10.1093/jnci/djr301 http://jnci.oxfordjournals.org/content/103/15/NP.2.full