October 27th is the 30th anniversary of the Mammography Quality Standards Act (MQSA). Congress enacted this law to safeguard nationwide access to quality mammography to detect breast cancer in its earliest, most treatable stages. With this Act, the federal government accredits, inspects, and certifies mammography facilities and standardizes mammography equipment, quality assurance, recordkeeping, and communication of results.
What’s missing from the MQSA is standardized language to inform women and providers if women have dense breast tissue – especially when considering that breast density is a risk factor for breast cancer almost half of all women have dense breasts.
Mammography machines may miss breast cancers for women with dense breasts and can have more false negatives (resulting in women being told they don’t have cancer when they do). Dense breasts can mask the tumors and make them more difficult for machines to detect.
Women need to know if they should discuss additional testing due to their breast density. Women with dense breasts may want additional screening such as MRI, ultrasound, or digital breast tomosynthesis. These tests can be more sensitive and might detect breast cancer that would remain hidden using traditional mammography.
However, the current federal guidelines do not require that women and providers are notified if she has dense breasts. Currently, 38 States and Washington D.C. require some level of notification to either the woman, provider, or both. But the details of what is communicated vary between states. State reporting requirements range from information about breast density in general to specific information on a patient’s breast density level and risk factors.
To be sure, providing women with more information about dense breasts may increase their worry about getting breast cancer. But more important than worrying is sharing information that motivates women to reach out to their health providers for additional screening.
It is true that the FDA has proposed a rule that would amend the mammography standard reporting requirements to require the provider’s written report of the results include information about the breast density of patients. But this amendment was put on the table in 2019, and there are no official changes to date.
The U.S. Preventive Services Task Force (USPSTF) concluded in 2016 that the current science was insufficient to recommend additional screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
The USPSTF recommendations matter as they are considered definitive standards for preventive services. If the USPSTF is recognized by the Patient Protection and Affordable Care Act, preventive services with a grade of A or B must be covered without cost-sharing (e.g., copayment or deductible) under new health insurance plans or policies. However, the USPSTF recommendations on screening for breast cancer are currently being updated.
Women can find out where their state stands on communication about breast density information at densebreast-info.org. We can also take longer-term actions by reaching out to elected officials. Ask Senators and Congressional Representatives to expand the Mammography Quality Standards Act to require standardized communication about breast density information to women and health providers. Women who are advocates for breast health and the health expert community can also provide public commentary on the upcoming U.S. Preventive Services Task Force Recommendation.
Better guidelines that consider breast density when screening for breast cancer are critical for women’s health. The sooner a woman knows she has cancer, the sooner she can be treated. Earlier treatment saves lives.
Veronica Irvin is an epidemiologist.
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