What you Need to Know About Iowa’s New Breast Density Law    

By Cindy Hadish

Like many states, Iowa recently enacted a new breast density law which will go into effect January 1, 2018. The aim of the new notification law is to help women understand what it means to have dense breast tissue.

We asked Dr Arnold Honick, mammography coordinator at Radiology Consultants of Iowa, to explain the law and what it means for patients.

What is the new breast density law?
The new law will require all mammography service providers to give every patient an explanation of the degree of her breast density, as well as general information about how dense breast tissue can potently interfere with detection of breast cancer on a mammogram.

What is breast Density?
“Breast tissue density is determined by the radiologist who reads the mammogram,” says Dr Honick. Breasts contain fatty tissue mixed with fibrous and glandular tissue. The less fatty tissue a woman has in her breasts, the more dense her breast tissue. Radiologists classify breast tissue density into four categories: fatty tissue, scattered fibroglandular tissue, heterogeneously dense tissue, and extremely dense tissue. The latter two categories are considered “dense.” 

Why is breast density important?
The density of breast tissue is important, Honick said, because the more dense the breast tissue, the more difficult it is to detect tumors using mammography. Additionally, patients with dense breasts have a higher risk of breast cancer. Dense breast tissue appears white on a mammogram, which is the same color as cancer cells, while fatty tissue appears as gray. “As the whiteness goes up, our ability to find tumors decreases,” Honick said. “So (dense tissue) can hide smaller lesions and that’s called the masking effect.”

When did breast density notification start?
In 2009, Connecticut became the first state to enact a density reporting law, inspired by a woman after her advanced stage breast cancer spread to her lymph nodes, and was discovered within weeks of her 11th normal mammogram. Doctors at that time finally revealed to her the challenges posed by her dense breast tissue in detecting cancer by mammography alone.

What if I do have dense breast tissue?
Honick noted that 40 percent of women in the U.S. have dense breast tissue, which is impossible to identify without a mammogram.  In our area, notification to patients with dense breast tissue will also include a note encouraging that person to discuss further screening with their clinician.

This is the wording patients will receive: “Your mammogram indicates that you have dense breast tissue. Dense breast tissue may make it more difficult to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. You are encouraged to consult with your primary health care provider regarding the results of your mammogram. Together you can best decide which additional screening options may be right for you based on your mammogram results, individual risk factors, or physical examination.”

If I have dense breast tissue, do I still need a mammogram?
“Yes, mammography is still the front-line,” Dr. Honick said. Mammograms are the only screening test proven to reduce breast cancer deaths. Many cancers are seen on mammograms even if you have dense breast tissue. RCI offers the option of 3D mammography, which takes multiple low-dose images of the breast at different angles, resulting in a series of one millimeter slices that radiologists can view as a 3D reconstruction of the breast. While 3D mammography is better at detecting tumors in dense breast tissue than standard mammography, Honick said additional screening may be recommended for some patients.

What other screening tests are used for dense breasts?
The next step for patients with dense breast tissue is ultrasound, which can detect smaller cancers that are missed by a mammogram.

Hospitals in Cedar Rapids also can screen patients with molecular breast imaging (MBI,) which requires patients to be injected with a radioactive tracer for the imaging process. This test has a higher cancer detection rate than ultrasound.

The last screening step would be magnetic resonance imaging, known as an MRI. Honick said the goal of all of the screening tests is earlier detection of breast cancer, the most commonly diagnosed cancer in women and the second leading cause of cancer death among women, following lung cancer.

It is important to note that not all insurance companies will cover the cost of supplemental screening exams. Patients are encouraged to check with their insurance companies prior to scheduling

a supplemental screening study. Contact RCI for pricing and payment options for these exams.

Recommended guidelines for mammography
RCI follows guidelines from the American College of Radiology and Mayo Clinic, which recommends a screening mammogram every year for women, beginning at age 40. Patients should consult with their doctor about having earlier screenings if they have a family history of breast cancer.

“It takes ongoing education, of both providers and patients,” Honick said of the new law. “The ongoing effort is to find breast cancers sooner.”

Ask your doctor for a referral to RCI, 1948 First Ave. NE, Cedar Rapids, or call for an appointment at 319-364-0121. See more at: www.rciowa.com

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