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Invited Commentary
July 1, 2019

Advising Women About Supplemental Screening After Dense Breast Notification: Still No Easy Answers

Author Affiliations
  • 1Yale School of Medicine, New Haven, Connecticut
  • 2Yale School of Public Health, New Haven, Connecticut
JAMA Intern Med. 2019;179(9):1240-1241. doi:10.1001/jamainternmed.2019.1737

Currently, 38 states have passed breast density notification laws. These laws vary by state, but generally require physicians to inform women when they are found to have dense breasts on mammography. Many state notifications also indicate that dense breasts can obscure abnormalities on a mammogram and are a risk factor for breast cancer. Some state laws specifically suggest a role for supplemental screening.1 More recently, the US Food and Drug Administration announced a proposed rule that would require all mammography reports in the United States to include such a notification.2 Under the proposed rule, all women would receive information about their own breast density as well as a notice encouraging them to discuss the findings with their physician. For women with dense breasts, the notification would also state, “Some patients with high breast density may need other imaging tests in addition to mammograms.”2 While well intentioned, these notifications strike many clinicians as blunt instruments. Breast density is only 1 aspect of breast cancer risk. Limiting discussions of supplemental screening to women with dense breasts may miss some high-risk women who do not have dense breasts, whereas many women with dense breasts may be at low risk overall. Could a more nuanced assessment of risk, beyond breast density, better identify women who are at high risk of a late-stage breast cancer diagnosis despite routine screening, and thus who might benefit from supplemental screening?

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