Breast Density Reporting Laws and Supplemental Screening-A Survey of Referring Providers' Experiences and Understanding

Santo IV Maimone, Michelle D. McDonough, Stephanie L. Hines

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Dense breast parenchyma obscures breast lesions on mammography and is an independent risk factor for development of breast cancer. Many states have approved laws requiring patient notification of dense breast tissue. Supplemental screening modalities are available however their utilization and efficacy are quite variable. Our aim was to survey primary care providers in an effort to gauge awareness of and familiarity with dense breast legislation and supplemental screening. A multisite survey was administered via e-mail to all Mayo Clinic staff physicians, residents and fellows, as well as nurse practitioners and physician assistants in the departments of Internal Medicine, Family Medicine, and Obstetrics and Gynecology. 362 responses were collected. 68% of respondents were aware of breast density notification laws; 32% had no knowledge of these laws. Implementation of supplemental imaging was variable. Of eligible respondents, 26% offered a supplemental examination to every patient with dense breasts, 47% offered it only to certain patients based upon unique patient or risk factors, 15% did not offer supplemental examinations, and 11% offered an examination based on other criteria. When assessing comfort level in answering questions regarding breast density, 32% were "slightly comfortable" and 18% were "not comfortable." When estimating the percentage of patients with adequate insurance coverage for supplemental imaging, 62% were unsure while 11% did not inquire. Despite public and legislative support, there is a lack of familiarity and considerable practice variation among primary care providers when managing patients with mammographically dense breast tissue. Further research and advances in patient and provider education on this topic are needed to improve management. Radiologists can assist by educating referring providers and consolidating imaging strategies to help circumvent systems-based flaws.

Original languageEnglish (US)
JournalCurrent Problems in Diagnostic Radiology
DOIs
StateAccepted/In press - 2016

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Breast
Primary Health Care
Physician Assistants
Insurance Coverage
Nurse Practitioners
Postal Service
Patient Education
Mammography
Internal Medicine
Gynecology
Legislation
Obstetrics
Breast Density
Surveys and Questionnaires
Medicine
Breast Neoplasms
Physicians
Research
Recognition (Psychology)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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abstract = "Dense breast parenchyma obscures breast lesions on mammography and is an independent risk factor for development of breast cancer. Many states have approved laws requiring patient notification of dense breast tissue. Supplemental screening modalities are available however their utilization and efficacy are quite variable. Our aim was to survey primary care providers in an effort to gauge awareness of and familiarity with dense breast legislation and supplemental screening. A multisite survey was administered via e-mail to all Mayo Clinic staff physicians, residents and fellows, as well as nurse practitioners and physician assistants in the departments of Internal Medicine, Family Medicine, and Obstetrics and Gynecology. 362 responses were collected. 68{\%} of respondents were aware of breast density notification laws; 32{\%} had no knowledge of these laws. Implementation of supplemental imaging was variable. Of eligible respondents, 26{\%} offered a supplemental examination to every patient with dense breasts, 47{\%} offered it only to certain patients based upon unique patient or risk factors, 15{\%} did not offer supplemental examinations, and 11{\%} offered an examination based on other criteria. When assessing comfort level in answering questions regarding breast density, 32{\%} were {"}slightly comfortable{"} and 18{\%} were {"}not comfortable.{"} When estimating the percentage of patients with adequate insurance coverage for supplemental imaging, 62{\%} were unsure while 11{\%} did not inquire. Despite public and legislative support, there is a lack of familiarity and considerable practice variation among primary care providers when managing patients with mammographically dense breast tissue. Further research and advances in patient and provider education on this topic are needed to improve management. Radiologists can assist by educating referring providers and consolidating imaging strategies to help circumvent systems-based flaws.",
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