By Christine Mitchell
Christine Mitchell is a sophomore at the University of Pennsylvania studying nursing.
Mammograms have long been heralded as a key component of women’s health. If performed regularly, they offer the potential to catch breast cancer before it becomes invasive, leading to lifesaving early interventions. While it is clear that mammography has had a positive impact on breast cancer treatment throughout the world, new legislation may risk taking the technology too far.
A mammogram is simply an x-ray image of the breast that is used to spot any unusual tissue masses, such as tumors. Although the recommended frequency of mammograms is controversial, The National Breast Cancer Foundation recommends that women aged forty and older receive a mammogram every one to two years. [1] The true controversy, however, is what doctors must report to patients following a mammogram. A mammogram can reveal dense breast tissue which is found in about half of the female population and is difficult to image using mammography. [2] While dense breasts do not cause breast cancer, they do make the disease more difficult to detect. Laws that have been passed in twenty-four states, and are pending in eleven others, require a physician to report any dense breast tissue detected by a mammogram to the patient, usually by mail after the visit. [3] These laws have been lobbied for by Are You Dense?, an advocacy group dedicated to passing density reporting laws. [4]
Christine Mitchell is a sophomore at the University of Pennsylvania studying nursing.
Mammograms have long been heralded as a key component of women’s health. If performed regularly, they offer the potential to catch breast cancer before it becomes invasive, leading to lifesaving early interventions. While it is clear that mammography has had a positive impact on breast cancer treatment throughout the world, new legislation may risk taking the technology too far.
A mammogram is simply an x-ray image of the breast that is used to spot any unusual tissue masses, such as tumors. Although the recommended frequency of mammograms is controversial, The National Breast Cancer Foundation recommends that women aged forty and older receive a mammogram every one to two years. [1] The true controversy, however, is what doctors must report to patients following a mammogram. A mammogram can reveal dense breast tissue which is found in about half of the female population and is difficult to image using mammography. [2] While dense breasts do not cause breast cancer, they do make the disease more difficult to detect. Laws that have been passed in twenty-four states, and are pending in eleven others, require a physician to report any dense breast tissue detected by a mammogram to the patient, usually by mail after the visit. [3] These laws have been lobbied for by Are You Dense?, an advocacy group dedicated to passing density reporting laws. [4]
The intent behind these laws is that if women are aware of their breast density, they will be able to make more educated decisions about their healthcare. Although improved health awareness is generally to be supported, it is not as clear-cut in this case. The first problem arises from the idea of a “dense breast.” There is no standard measure of whether or not breast tissue can be classified as “dense”; the classification is made solely by the impression of the one clinician reading the scan. [5] One doctor stated that the determination of whether or not a woman’s breast is dense is “very subjective” and “varies wildly” between radiologists. [6] Reporting dense breasts from mammography screening does not provide any value until the diagnosis is standardized. At this point, doctors could be giving women frightening health news based off of purely subjective measures.
At this point in time, there is no clear path forward for those who have such a diagnosis. Although screening exists beyond mammograms, including MRIs and ultrasounds, these methods have been associated with high levels of false-positives and unnecessary biopsies. [7] When discussing the impact of mandatory reporting on women’s health, one Harvard researcher stated, “At this point, we can’t tell a woman with high density what she can do to decrease her risk. All you do is increase her anxiety.” [8] The general consensus of physicians has been that of uncertainty; while these laws have resulted in increasing the fear that women have of being diagnosed with breast cancer, they have not succeeded in providing more successful treatment or intervention. [9]
Mandatory density reporting laws have also neglected to address a vital component of any health care legislation: insurance coverage. Only two of the states that have passed or are considering passing mandatory reporting laws have included language that requires insurers to cover additional screening for those with dense breasts. [10] In most states, even if a woman were to seek additional screening, it is unlikely that she would be able to access it without paying out-of-pocket. This puts women in a position where they are informed of a potential threat to their health, but are unable to do anything about it.
While breast density reporting laws have good intentions, it is clear that they push beyond the capabilities of current medical knowledge and technology. Instead of increasing anxiety without improving outcomes, efforts should be focused on actions such as instructing women how to perform self-breast exams, and ensuring that mammograms are easily accessible and affordable. If a woman wishes to know their breast density, they should be able to have that conversation with their physician. They should not, however, be forced to learn their density; especially when no clear testing or treatment options exist.
[1] National Breast Cancer Foundation. “Mammogram.” 2015. Accessed March 17, 2016. http://www.nationalbreastcancer.org/mammogram.
[2] National Institute of Biomedical Imaging and Bioengineering. “Mammography.” Accessed March 17, 2016. https://www.nibib.nih.gov/science-education/science-topics/mammography
[3] Are You Dense Advocacy. “D.E.N.S.E State Efforts” 2016. Accessed March 17, 2016. http://areyoudenseadvocacy.org/dense/
[4] Ibid.
[5] Lee, Carol. “Dense Breast Tissue and Screening.” Radiology Today. January 2014. Accessed March 16, 2016. http://www.radiologytoday.net/archive/rt0114p30.shtml
[6] Ibid.
[7] Gorski, David. “Mandatory Breast Density Reporting Legislation.” June 8, 2015. Accessed March 16, 2016. https://www.sciencebasedmedicine.org/mandatory-breast-density-reporting-legislation-the-law-outpaces-science-and-not-in-a-good-way/
[8] Peres, Judy. “Laws Get Ahead of Doctors on Mammography, Breast Density.” The Chicago Tribune. October 16, 2015. Accessed March 16, 2016. http://www.chicagotribune.com/lifestyles/health/breastcancer/sc-breast-cancer-density-health-20150924-story.html
[9] Lee, Carol. “Dense Breast Tissue and Screening.” Radiology Today. January 2014. Accessed March 16, 2016. http://www.radiologytoday.net/archive/rt0114p30.shtml
[10] Are You Dense Advocacy. “D.E.N.S.E State Efforts” 2016. Accessed March 17, 2016. http://areyoudenseadvocacy.org/dense/
The opinions and views expressed through this publication are the opinions of the designated authors and do not reflect the opinions or views of the Penn Undergraduate Law Journal, our staff, or our clients.
Photo Credit: Flickr User NASA Goddard Space Flight Center
At this point in time, there is no clear path forward for those who have such a diagnosis. Although screening exists beyond mammograms, including MRIs and ultrasounds, these methods have been associated with high levels of false-positives and unnecessary biopsies. [7] When discussing the impact of mandatory reporting on women’s health, one Harvard researcher stated, “At this point, we can’t tell a woman with high density what she can do to decrease her risk. All you do is increase her anxiety.” [8] The general consensus of physicians has been that of uncertainty; while these laws have resulted in increasing the fear that women have of being diagnosed with breast cancer, they have not succeeded in providing more successful treatment or intervention. [9]
Mandatory density reporting laws have also neglected to address a vital component of any health care legislation: insurance coverage. Only two of the states that have passed or are considering passing mandatory reporting laws have included language that requires insurers to cover additional screening for those with dense breasts. [10] In most states, even if a woman were to seek additional screening, it is unlikely that she would be able to access it without paying out-of-pocket. This puts women in a position where they are informed of a potential threat to their health, but are unable to do anything about it.
While breast density reporting laws have good intentions, it is clear that they push beyond the capabilities of current medical knowledge and technology. Instead of increasing anxiety without improving outcomes, efforts should be focused on actions such as instructing women how to perform self-breast exams, and ensuring that mammograms are easily accessible and affordable. If a woman wishes to know their breast density, they should be able to have that conversation with their physician. They should not, however, be forced to learn their density; especially when no clear testing or treatment options exist.
[1] National Breast Cancer Foundation. “Mammogram.” 2015. Accessed March 17, 2016. http://www.nationalbreastcancer.org/mammogram.
[2] National Institute of Biomedical Imaging and Bioengineering. “Mammography.” Accessed March 17, 2016. https://www.nibib.nih.gov/science-education/science-topics/mammography
[3] Are You Dense Advocacy. “D.E.N.S.E State Efforts” 2016. Accessed March 17, 2016. http://areyoudenseadvocacy.org/dense/
[4] Ibid.
[5] Lee, Carol. “Dense Breast Tissue and Screening.” Radiology Today. January 2014. Accessed March 16, 2016. http://www.radiologytoday.net/archive/rt0114p30.shtml
[6] Ibid.
[7] Gorski, David. “Mandatory Breast Density Reporting Legislation.” June 8, 2015. Accessed March 16, 2016. https://www.sciencebasedmedicine.org/mandatory-breast-density-reporting-legislation-the-law-outpaces-science-and-not-in-a-good-way/
[8] Peres, Judy. “Laws Get Ahead of Doctors on Mammography, Breast Density.” The Chicago Tribune. October 16, 2015. Accessed March 16, 2016. http://www.chicagotribune.com/lifestyles/health/breastcancer/sc-breast-cancer-density-health-20150924-story.html
[9] Lee, Carol. “Dense Breast Tissue and Screening.” Radiology Today. January 2014. Accessed March 16, 2016. http://www.radiologytoday.net/archive/rt0114p30.shtml
[10] Are You Dense Advocacy. “D.E.N.S.E State Efforts” 2016. Accessed March 17, 2016. http://areyoudenseadvocacy.org/dense/
The opinions and views expressed through this publication are the opinions of the designated authors and do not reflect the opinions or views of the Penn Undergraduate Law Journal, our staff, or our clients.
Photo Credit: Flickr User NASA Goddard Space Flight Center
