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Showing content from https://pubmed.ncbi.nlm.nih.gov/27799412/ below:

The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening

doi: 10.1177/2150131916674889. Epub 2016 Oct 31. The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening

Affiliations

¹ 1 Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
² 2 Kaiser Permanente Northern California, Oakland, CA, USA.

PMID: 27799412
PMCID: PMC5932660
DOI: 10.1177/2150131916674889

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The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening

Stephanie Lynn Chau et al. J Prim Care Community Health. 2017 Apr.

doi: 10.1177/2150131916674889. Epub 2016 Oct 31. Affiliations

¹ 1 Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
² 2 Kaiser Permanente Northern California, Oakland, CA, USA.

PMID: 27799412
PMCID: PMC5932660
DOI: 10.1177/2150131916674889

Item in Clipboard

Abstract

Purpose: Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California's 2013 BD notification legislation on breast cancer screening patterns.

Methods: We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b).

Results: After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b).

Conclusions: In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

Keywords: California; breast MRI; breast cancer; breast density; cancer screening; mammography; notification legislation; supplementary screening.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures
Figure 1.

Distribution of breast density categories…

Figure 1.

Distribution of breast density categories (April 2013 to March 2015): (a) overall; (b)…

Figure 1.

Distribution of breast density categories (April 2013 to March 2015): (a) overall; (b) by race/ethnicity; (c) by age; and (d) Neighborhood median income. Heterogen. dense, heterogenously dense; Native Am, Native American.

Figure 2.

Adjusted odds ratios ^a and…

Figure 2.

Adjusted odds ratios ^a and confidence bounds for having screening magnetic resonance imaging…

Figure 2.

Adjusted odds ratios^a and confidence bounds for having screening magnetic resonance imaging (MRI) within 9 months of screening mammogram in the postlegislative period. Ref, reference. ^a Odds ratios estimated by logistic regression controlled for all variables in the figure plus medical center and cancer history.