For many of the women who are scheduling the screening mammograms that were deferred in the spring, their health care decisions are being guided in part by knowledge gleaned from 10 years of dense breast notification laws.
Referring health care providers are becoming increasingly responsible for guiding discussions with their patients about what breast density means, and whether supplemental screening ultrasound of patients with dense breasts might be beneficial.
In a scientific paper published in June 2020 in the American Journal of Roentgenology, “Screening Breast Ultrasound: Update After 10 Years of Breast Density Notification Laws,” Reni S. Butler, MD, and Regina J. Hooley, MD, of the Department of Radiology & Biomedical Imaging at Yale School of Medicine (YSM), explain that increasing recognition of limited mammographic sensitivity in women with dense breasts has led to greater use of supplemental screening ultrasound. “Data support improved detection of small node-negative invasive breast cancers with added ultrasound for women with dense breasts,” explained Butler, an Associate Professor of Radiology, and Hooley, a Professor of Radiology & Biomedical Imaging.
Breast density notification laws have grown from the first state legislation enacted in Connecticut in 2009 to a federally mandated update to the Mammography Quality Standards Act passed in 2019. Mammography is the standard screening test for breast cancer and is proven to reduce deaths from breast cancer. However, in dense breasts – breasts with a lot of fibrous or glandular tissue and not much fat – cancers can be hidden on mammography and may go undetected until they are larger and more likely to spread. Other screening tests, such as supplemental ultrasound, substantially increase the detection of early-stage breast cancer in women with dense breasts. Digital breast tomosynthesis and other emerging forms of screening may also play a role in screening guidelines, said Butler and Hooley.
Breast density is determined through a woman’s mammogram. Forty percent of women in the U.S. age 40 and over who have been screened for breast cancer have dense breasts. Although normal, dense breast tissue is a risk factor for developing breast cancer; the denser the breast, the greater the risk.
“Breast density is important for women to know,” said Hooley, who is Acting Division Chief for Breast Imaging at YSM. “Women with dense breasts have an increased risk of breast cancer, and dense breasts make it more difficult to see a small cancer on a mammogram,” she said. “The notification law empowers women and makes them smarter about their health.”
For women returning to Yale for mammograms as well as other imaging tests, new COVID-19 safety precautions have been put in place to protect patients and staff. This spring, the Radiology & Biomedical Imaging Department at Yale New Haven Health enlisted volunteers from the hospital staff to have screening mammograms in order to test new safety operations. Among the precautions are triple screening of patients for COVID-19 symptoms, consistent cleaning of imaging machines following Centers for Disease Control and Prevention standards, and less time spent in waiting areas.
New schedules for patients, including extended and weekend hours, are being offered in uncrowded waiting spaces. The department is also spacing out the chairs in its waiting room if a patient should have to use them. There is new signage for waiting rooms, floor markings, and Plexiglas guards have been installed.
YSM’s breast imaging section recently welcomed three new radiologists:
- Kiran Sheikh, MD, who joins Yale from Advanced Radiology Consultants in Shelton, Conn.
- Dorothy Sippo, MD, previously an instructor in radiology at Harvard Medical School
- Ross Varma, MD, a recent fellow in breast imaging at Moffitt Cancer Center in Florida