Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel
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Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review, the Cochrane review, National Comprehensive Cancer Network guidelines, American Cancer Society recommendations, and American College of Radiology appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (<15 % lifetime risk), do not routinely require supplemental screening per the expert consensus. Women of high risk (>20 % lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman.
KeywordsScreening Density Dense breasts Mammography Supplemental screening
The authors would like to acknowledge Edward J. Brennan, JD and Valerie Fein-Zachary, MD for their assistance.
Compliance with ethical standards
Conflict of Interest
A. Alan Semine is a consultant/advisory role for Hologic, Inc. Kevin S. Hughes is a member of the Myriad Genetics Speaker Bureau and is a founder of and has a financial interest in Hughes Risk Apps, LLC. Dr. Hughes's interests were reviewed and are managed by Massachusetts General Hospital and Partners Health Care in accordance with their conflict of interest policies. The remaining authors declare no conflict of interest.
- 1.Are You Dense Advocacy, Inc. D.E.N.S.E.® State Efforts. http://areyoudenseadvocacy.org/dense/. Accessed Jan 2015
- 3.Tice JA, Ollendorf DA, Lee JM, Pearson SD. The comparative clinical effectiveness and value of supplemental screening tests following negative Mammography in women with dense breast tissue. Institute for clinical and economic review (ICER) 2013. http://www.ctaf.org/sites/default/files/assessments/ctaf-final-report-dense-breast-imaging-11.04.2013-b.pdf. Accessed 5 Dec 2014
- 4.California Technology Assessment Forum (CTAF) supplemental cancer screening for women with dense breasts: questions for deliberation and results. September 25, 2013. http://www.ctaf.org/sites/default/files/u39/Voting%20question%20main_results.pdf. Accessed 5 Dec 2014
- 5.New England Comparative Effectiveness Public Advisory Council (CEPAC). An action guide for supplemental cancer screening for women with dense breasts: next steps for patients, clinicians, and insurers. http://cepac.icer-review.org/wp-content/uploads/2013/11/Action-Guide-Dense-Breast-Final.pdf. Date of publication March 2014. Accessed 5 Dec 2014
- 8.National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2014 Breast cancer screening and diagnosis. Breast Cancer. http://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Published 5/30/14. Accessed 5 Dec 2014
- 14.D’Orsi CJ, Mendelson EB, Morris EA et al (2012) ACR BI-RADS: Breast Imaging Reporting and Data System, 5th edn. Am Coll Radiol, RestonGoogle Scholar
- 23.Skaane P, Osteras BH, Eben EB, Gullien R.VSBR31-16: Comparison of digital mammography (FFDM) and FFDM plus tomosynthesis in mammography screening for cancer detection according to breast parenchyma density. Abstract, Radiological Society North America, Chicago, IL. December 2014Google Scholar
- 29.The 188th General Court of the Commonwealth of Massachusetts. Session Laws, Acts of 2014. Chapter 150: An Act Relative to Breast Cancer Early Detection. https://malegislature.gov/Laws/SessionLaws/Acts/2014/Chapter150. Accessed 4 Jan 2015
- 30.Freer PE, Kopans DB (2010) Screening for breast cancer: mammography and other modalities. In: Taghian AG, Smith BL, Erban JK (eds) Breast Cancer: A Multidisciplinary Approach to Diagnosis and Management (Current Multidisciplinary Oncology). Demos Medical, New York, pp 18–36Google Scholar
- 41.Tice JA, Cummings SR, Smith-Bindman R, Ichikawa L, Barlow WE, Kerlikowske K (2008) Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model. Ann Intern Med. 148(5):337–347. Summary for patients in: Ann Intern Med. 2008 Mar 4;148(5):I34 Google Scholar
- 45.The American Society of Breast Surgeons position on mammography. Approved Aug 15, 2011. https://www.breastsurgeons.org/statements/PDF_Statements/Screening_Mammography.pdf.Accessed 4 Dec 2015
- 47.Committee on Gynecologic Practice, The American College of Obstetricians and Gynecology Committee Opinion Number 593 (2014) Management of women with dense breasts diagnosed by mammography. Obstet Gynecol 123(4):910–911Google Scholar
- 49.Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thorton C, Moskowitz CS, Ferrara J, Morris EA (2013) Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology 266:743–751CrossRefPubMedGoogle Scholar
- 50.Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB (2014) Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection—a novel approach to breast cancer screening with MRI. J Clin Oncol 32(22):2304–2310CrossRefPubMedGoogle Scholar