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California OKs Dense Breasts Notification Bill

September 15, 2011
Written by: , Filed in: Breast Imaging, Medical Ethics
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A bill requiring that California women be told if a mammogram reveals they have dense breasts has one last hurdle to meet before it can become law: Governor Jerry Brown’s signature.

The bill passed the Legislature on Monday, despite opposition from the California Radiological Association and California Medical Association, among other medical groups. They succeeded in blocking the original bill, but its sponsor, State Senator Joe Simitian, D-Palo Alto, incorporated the bill’s language into another bill at the last minute and managed to get it passed.

According to Senator Simitian, the bill requires that, when mammograms reveal dense breast tissue, doctors must add two sentences to the federally required letter that a radiologist must send a patient after performing the mammogram:

Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office and you should contact your physician if you have any questions or concerns about this notice.

Dense breast tissue has been identified as a risk factor for breast cancer. So why would the medical groups object? They listed several reasons, not necessarily in this order:

  • The grading of breast density is subjective, leaving doctors open to lawsuits if patients with breasts not classified as “dense” are later diagnosed with breast cancer.
  • Dense breast tissue is common, and many patients who otherwise are at low risk (no family or personal history of breast cancer, no precancerous changes, etc.) will suffer needless anxiety.
  • “Doctors are all going to be overwhelmed by calls, and many of them are not going to be necessary because of their low risk” (per Ruth Haskins, MD, an obstetrician and gynecologist who is chairwoman of the Council on Legislation for the California Medical Association, as quoted by the San Jose Mercury News).
  • Follow-up screening will be expensive and may not be covered by insurance (for those who even have insurance).

As Dr. Haskins (whose association favored giving physicians discretion to inform patients about dense breasts based on other risk factors and the doctors’ medical judgment) put it before the bill was passed:

The problem with this bill is that it gives a boatload of power to a lot of women who then become powerless to use that information.

To which Senator Simitian replies: “To tell a patient she has no right to know information already held by the radiologist and physician is indefensible. These are two sentences that can save thousands of lives.”

Simitian introduced the legislation at the request of Amy Colton, a now-50-year-old registered nurse who got a mammogram every year starting at age 40. Each year, she got an all-clear—and then, two years ago, she was diagnosed with late-stage breast cancer.

That’s when she learned that she had breast dense tissue, and that both her radiologist nor her primary-care physician had known, but hadn’t told her. (She received successful treatment and says she feels “great.”)

“I’m the patient,” Colton said. “It’s my body. But I was never informed.”

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One Response to “California OKs Dense Breasts Notification Bill”

  1. Radiology Daily»AlertArchive » Veto Stops CA Breast Density Notification Bill on October 10th, 2011 at 10:01 am

    […] his veto message, Brown zeroed in on the specific language of the required notification. As we reported last month, the bill would have added the following two sentences to the federally required letter that a […]