Impact of the New Jersey Breast Density Law on Imaging and Intervention Volumes and Breast Cancer Diagnosis

Sanders, Linda M.; King, Alexander B.; Goodman, Koren S.

doi:10.1016/j.jacr.2016.05.005

Cited by 25 publications

(25 citation statements)

References 11 publications

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“…All eligible studies are described, and their main findings summarised in Table 1. Studies were retrospective studies of medical or imaging records (18, 20, 27, 30, 34, 35, 37, 38), retrospective studies using sourced population datasets (26, 28), survey (or interview-based) studies (17, 19, 21–25, 29, 31, 32), and studies using micro-simulation modelling (33, 36). …”

Section: Resultsmentioning

confidence: 99%

“…Many studies undertook comparisons using a ‘before/after’ methodology, that is comparing outcomes of interest pre- and post-legislation (20, 28, 30, 34, 35, 38) or compared radiologists’ (or radiology facilities’) practices or states with versus without enacted BD legislation (24, 26, 29); one study integrated both forms of comparisons (26). On the other hand, several studies solely described or explored factors (such as women’s or health practitioners’ knowledge) post-enactment of BD legislation (17, 19, 22, 23, 25, 32), or described post-legislation test performance or utilisation (18, 27, 37).…”

Section: Resultsmentioning

confidence: 99%

“…These studies reported on various observed outcomes (18, 20, 26–30, 34, 35, 37, 38), perceived or expressed behavioural measures (17, 19, 21–25, 31, 32), or modelled outcomes (33, 36): study-specific results are detailed in Table 1. The group of studies exploring the effect of BD legislation on women, radiologists or physicians, reported on various domains such as knowledge, awareness, perceptions, attitudes and behaviour; or changes in practice or density reporting.…”

Section: Resultsmentioning

confidence: 99%

“…Despite heterogeneity in the types of studies assessing the impact of BD legislation and variability in their findings as outlined in the study-specific summaries (Table 1), some key themes emerged from the tabulated information: Supplemental screening: the introduction of BD legislation was followed by increases in supplemental screening rates (ultrasound, MRI) (18, 20, 27, 29, 30, 34, 35, 37, 38), and a suggestion of a decrease in mammography rates in two (relatively large) studies evaluating that outcome (20, 30); several studies of supplemental screening also documented additional cancer detection in the range of 1.8 to 3.2 cancers per 1000 supplemental screens (27, 35, 37). …”

Section: Resultsmentioning

confidence: 99%

“…Although the decrease in mammography rates has been reported in only two studies (both reporting around a 6% reduction)(20, 30), these studies were based on relatively larger imaging datasets than other studies of screening utilisation (Table 1) – this raises concern that some women maybe opting to undergo ultrasound (with unproven health benefit) for primary screening and foregoing mammography. Thus, future studies of supplemental screening, in the setting of enacted BD notification, should also monitor the effect on mammography screening rates rather than merely reporting supplemental screening rates.…”

Section: Discussionmentioning

confidence: 98%

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The impact of legislation mandating breast density notification – Review of the evidence

Houssami

Lee

2018

The Breast

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Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. The enactment of BD legislation in a majority of states in the USA mandating notification of risks associated with BD directly to women undergoing mammography has catapulted interest in BD among women, physicians, and policymakers. We therefore report a descriptive review of the evidence on the impact of enactment of BD legislation. Based on 22 eligible studies, we identified four broad themes of research: studies of the impact on screening rates, most showing increased utilisation of supplemental screening; studies exploring the effect on women, radiologists, or primary physicians (reporting heterogeneous effects on knowledge, awareness, perceptions, attitudes and behaviour; and changes in practice); few studies assessing the population impact (effect on screening outcomes or breast cancer stage); and studies of costs highlighting the economic burden from supplemental screening. Given that many of the studies were retrospective single institution studies (comparing pre- and post-legislation) or small surveys with a paucity of population-level studies, we highlight areas meriting additional research. The information described in this review can inform research priorities where BD legislation has been introduced and can be used to guide world-wide policy or practice decisions where BD legislation may be under debate or contemplation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

See 3 more Smart Citations

The impact of legislation mandating breast density notification – Review of the evidence

Houssami

Lee

2018

The Breast

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Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk

et al. 2019

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IMPORTANCE Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. OBJECTIVE To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study. Two Breast Cancer Surveillance Consortium registries provided prospectively collected data on screening mammography with vs without same-day breast ultrasonography from January 1, 2000, to December 31, 2013. The dates of analysis were March 2014 to December 2018. A total of 6081 screening mammography plus same-day screening ultrasonography examinations in 3386 women were propensity score matched 1:5 to 30 062 screening mammograms without screening ultrasonography in 15 176 women from a sample of 113 293 mammograms. Exclusion criteria included a personal history of breast cancer and self-reported breast symptoms. EXPOSURES Screening mammography with vs without screening ultrasonography. MAIN OUTCOMES AND MEASURES Cancer detection rate and rates of interval cancer, false-positive biopsy recommendation, short-interval follow-up, and positive predictive value of biopsy recommendation were estimated and compared using log binomial regression. RESULTS Screening mammography with vs without ultrasonography examinations was performed more often in women with dense breasts (74.3% [n = 4317 of 5810] vs 35.9% [n = 39 928 of 111 306] in the overall sample), in women who were younger than 50 years (49.7% [n = 3022 of 6081] vs 31.7% [n = 16 897 of 112 462]), and in women with a family history of breast cancer (42.9% [n = 2595 of 6055] vs 15.0% [n = 16 897 of 112 462]). While 21.4% (n = 1154 of 5392) of screening ultrasonography examinations were performed in women with high or very high (Ն2.50%) Breast Cancer Surveillance Consortium 5-year risk scores, 53.6% (n = 2889 of 5392) had low or average (<1.67%) risk. Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk [RR], 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71). CONCLUSIONS AND RELEVANCE In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.

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Breast cancer supplemental screening: Women’s knowledge and utilization in the era of dense breast legislation

et al. 2020

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Impact of the New Jersey Breast Density Law on Imaging and Intervention Volumes and Breast Cancer Diagnosis

Cited by 25 publications

References 11 publications

The impact of legislation mandating breast density notification – Review of the evidence

The impact of legislation mandating breast density notification – Review of the evidence

Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk

Breast cancer supplemental screening: Women’s knowledge and utilization in the era of dense breast legislation

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