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


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.

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The authors would like to acknowledge Edward J. Brennan, JD and Valerie Fein-Zachary, MD for their assistance.

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Correspondence to Phoebe E. Freer.

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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.

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Paper drafted while was Instructor in Radiology at Harvard Medical School/Massachusetts General Hospital. Will be Associate Prof of Radiology at University of Utah/Huntsman Cancer Institute Summer 2015.

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Freer, P.E., Slanetz, P.J., Haas, J.S. et al. 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. Breast Cancer Res Treat 153, 455–464 (2015).

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  • Screening
  • Density
  • Dense breasts
  • Mammography
  • Supplemental screening