Breast Density Notification Legislation and Breast Cancer Stage at Diagnosis: Early Evidence from the SEER Registry

  • Ilana Richman
  • Steven M. Asch
  • Eran Bendavid
  • Jay Bhattacharya
  • Douglas K. Owens
Original Research

DOI: 10.1007/s11606-016-3904-y

Cite this article as:
Richman, I., Asch, S.M., Bendavid, E. et al. J GEN INTERN MED (2016). doi:10.1007/s11606-016-3904-y

Abstract

Background

Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography.

Objective

To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation.

Design

Using a difference-in-differences analysis, we examined changes in stage at diagnosis among women with breast cancer in Connecticut, the first state to enact legislation, compared to changes among women in control states. We used data from the Surveillance, Epidemiology, and End Results Program (SEER) registry, 2005–2013.

Participants

Women ages 40–74 with breast cancer.

Intervention

Breast density notification legislation, enacted in Connecticut in October of 2009.

Main Measure

Breast cancer stage at diagnosis.

Key Results

Our study included 466,930 women, 25,592 of whom lived in Connecticut. Legislation was associated with a 1.38-percentage-point (95 % CI 0.12 to 2.63) increase in the proportion of women in Connecticut versus control states who had localized invasive cancer at the time of diagnosis, and a 1.12-percentage-point (95 % CI −2.21 to −0.08) decline in the proportion of women with ductal carcinoma in situ at diagnosis. Breast density notification legislation was not associated with a change in the proportion of women in Connecticut versus control states with regional-stage (−0.09 percentage points, 95 % CI −1.01 to 1.02) or metastatic disease (−0.24, 95 % CI −0.75 to 0.28). County-level analyses and analyses limited to women younger than 50 found no statistically significant associations.

Limitations

Single intervention state, limited follow-up, potential confounding from unobserved trends.

Conclusions

Breast density notification legislation in Connecticut was associated with a small increase in the proportion of women diagnosed with localized invasive breast cancer in individual-level but not county-level analyses. Whether this finding reflects potentially beneficial early detection or potentially harmful overdiagnosis is not known. Legislation was not associated with changes in regional or metastatic disease.

KEY WORDS

cancer screening breast cancer health policy 

Supplementary material

11606_2016_3904_MOESM1_ESM.docx (21 kb)
ESM 1(DOCX 20 kb)

Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Ilana Richman
    • 1
    • 2
  • Steven M. Asch
    • 1
    • 3
  • Eran Bendavid
    • 2
    • 3
  • Jay Bhattacharya
    • 2
  • Douglas K. Owens
    • 1
    • 2
  1. 1.Center for Innovation to ImplementationPalo Alto VA Health Care SystemPalo AltoUSA
  2. 2.Center for Primary Care and Outcomes Research/Center for Health PolicyStanford University School of MedicineStanfordUSA
  3. 3.Division of General Medical DisciplinesStanford University School of MedicineStanfordUSA