Why We Need a National Standard on Breast Density Reporting

Breast density inform laws exist in 38 states and DC. However, according to JoAnn Pushkin, Executive Director at DenseBreast-info Inc., not all state laws actually inform women if they have dense breasts and that a national standard should be adopted. She adds, “Some only require general information about breast density be supplied – without requiring a woman to be told that she herself has dense breasts!”

We at SmartBreast Corporation totally agree with Ms. Pushkin on the need for a national standard on breast density reporting that should include not only breast density classification, but also the associated implications on the risk for breast cancer, as well as the implications on the possibility of a missed cancer. A missed cancer is likely in breast density C (heterogeneously dense) and D (extremely dense) as mammographic sensitivity is known to decline sharply to 30% in extremely dense breasts. In such a situation, the BIRADS classification should be 0 (incomplete; needs additional imaging), instead of what is usually reported as BIRADS 2 (benign) as the language of the California Breast Density Notification Law (SB 1538) implicates that “Dense breast tissue is common and is not abnormal.” The report of a BIRADS 2 (benign) in an extremely dense breast can result in an interval breast cancer (IBC), referring to cancer detected after a normal screening mammogram but before the next scheduled mammogram. We would consider IBC as a delayed cancer diagnosis, as the potential to detect this earlier was missed had the BIRADS report been 0 (incomplete; needs additional imaging), and in such instance, trigger a secondary screening modality, such as ultrasound, MRI, molecular breast imaging (MBI), or contrast enhanced spectral mammography (CESM). Detecting breast cancer early avoids the cascade of more extensive surgery, more aggressive chemo- and immuno-therapies, and radiotherapy that is associated with later stage cancers. Furthermore, early breast cancer treatment is associated with less cost versus later-stage breast cancer, making early detection and early treatment a financially sound principle in the management of our healthcare system.