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Citizen's View: Breast imaging providers must lead density education

In January 2014, Oregon became the 11th state in the nation to pass a law requiring mammography providers to inform women patients with “extreme breast density” about their status and how this may impact the radiologist’s ability to detect cancer on a mammogram.

We have long made it a practice to have on-site reads of mammograms followed by in-person consultations with our patients. For women with dense breast tissue, we have performed same-day ultrasounds for the past 20 years. Therefore, the new law did not change anything in our practice other than a small edit in the official written notification to include the state-mandated density-inform language.

However, what did change with the passage of the law was broader community awareness of density, and not always in a positive way.

From a patient perspective, the longstanding recommendation of having an annual two-view, low-radiation-dose mammogram starting at age 40 no longer seemed so clear. Marketing of breast tomosynthesis with more images and more radiation was causing some patients to request the test when it was not appropriate for them.

There is a common misperception that more testing and newer options must mean more accurate results, even though, for the great majority of women who do not have dense breast tissue — and even for some who do — the additional testing has no added benefit.

Breast cancer is a highly emotional issue. Nearly every woman has at least one friend or family member who has been touched by breast cancer. The anxiety can be intense. In our practice, my partner, Robert Seapy, and I provide immediate mammogram reads. Making patients wait to learn their results by mail or phone when an immediate read is possible is just not acceptable.

For the majority of patients, dense breast tissue that may obscure cancer is not an issue and a traditional 2D mammogram is the only test they need. When the mammogram does show dense tissue, we explain this to the patient at the same appointment as the mammogram and discuss additional screening options right then.

We find that when patients fully understand all of their screening options, nearly all prefer a breast ultrasound for secondary screening because the exam is comfortable, they do not receive unnecessary additional radiation, and the exam is accurate. In addition, because our workflow is to perform any needed follow-up ultrasound imaging and needle biopsies at the same appointment as the mammogram to reduce the anxiety of waiting for results, our patients can have the test done before they go home.

Amy S. Thurmond, M.D., is director of Women’s Imaging and Intervention in Lake Oswego and has more than 30 years of experience in women’s imaging.


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