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The impact of mandatory mammographic breast density notification on supplemental screening practice in the United States: a systematic review

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Abstract

Purpose

Dense breast tissue is an independent risk factor for breast cancer and lowers the sensitivity of screening mammography. Supplemental screening with ultrasound or MRI improves breast cancer detection rate but has potential harms. Breast density notification (BDN) legislation has been introduced in the United States (US) and its impact on supplemental screening practice is unclear. This study systematically reviewed current evidence to explore the impact of BDN on supplemental screening practice in the US.

Methods

Medline, PubMed, Embase, Cochrane and the Cinhal Library databases were searched (2009-August 2020). Studies were assessed for eligibility, data were extracted and summarised, and study quality was evaluated.

Results

Evidence from the included studies (n = 14) predominantly showed that BDN legislation increased the overall utilisation of supplemental screening by 0.5–143%. This effect was amplified if the notification included a follow-up telephone call informing women about additional screening benefits, and if the state’s law mandated insurance cover for supplemental screening. Likelihood of supplemental screening was also influenced by history of breast biopsy and family history of breast cancer, race, age, socioeconomic status, density category, and physician’s specialty and region. Some studies reported increases in biopsy rate (up to 4%) and cancer detection rate (up to 11%) after implementation of BDN legislation.

Conclusion

BDN leads to increased use of supplemental screening. This has implications for women and the health system. These findings can help inform current and future screening programs, where breast density notification is currently implemented or being considered.

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Funding

Nehmat Houssami is supported by a National Health and Medical Research Council (NHMRC) Investigator (Leader) Grant #1194410.

Author information

Author notes

  1. Meagan Brennan and Brooke Nickel are the Joint senior authors.

Authors and Affiliations

  1. Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    Shuangqin Huang, Nehmat Houssami & Brooke Nickel

  2. School of Medicine Sydney, University of Notre Dame Australia, Oxford St, Darlinghurst, NSW, Australia

    Meagan Brennan

  3. Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    Meagan Brennan

Authors
  1. Shuangqin Huang
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  2. Nehmat Houssami
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Contributions

NH, MB and BN conceived the study. SH and BN screened title and abstracts. SH, MB and BN completed the full text review and data extraction. SH completed the data synthesis with support from MB and BN. SH, MB and BN conducted the risk of bias assessment. SH wrote the manuscript with input from NH, MB and BN.

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Correspondence to Meagan Brennan.

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Huang, S., Houssami, N., Brennan, M. et al. The impact of mandatory mammographic breast density notification on supplemental screening practice in the United States: a systematic review. Breast Cancer Res Treat 187, 11–30 (2021). https://doi.org/10.1007/s10549-021-06203-w

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  • DOI: https://doi.org/10.1007/s10549-021-06203-w

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