Less than a year after California’s law-makers passed a disputed law requiring all radiologists to inform women if they have dense breast tissue, a team of researchers from the University of California Davis discovered that 50 percent of primary care physicians are still unaware of this law, and that most of them are uncomfortable talking about the patient’s breast density with them.
These findings from UC Davis’ study, titled, “Impact of the California Breast Density Law on Primary Care Physicians,” are due to be published in the upcoming March issue of the Journal of the American College of Radiology, and suggest that if any laws concerning patient care are to make a significant impact, physicians need to be well-informed and trained, particularly with breast density and alternatives in breast imaging.
“Overall, the impact of the breast density legislation probably is not significant if primary care physicians are not educated or aware of it,” study’s lead author Kathleen Khong, a UC Davis radiologist and staff physician, said in a news release. “We should put some emphasis on educating the primary care physicians so that when they get questions from patients, they can be comfortable in addressing the issues.”
According to the law, physicians are mandated to notify patients whose breast tissue density is classified as “heterogeneously dense” or “extremely dense,” which is normally the case in about 50 percent of women. The notification will read as follows: “Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”
The UC Davis researchers emphasized that while a patient’s breast density has always been a requirement in any radiological assessment report post-mammography, a patient would have to request to see the findings. Otherwise, the report will only be shared with the primary care physician. What boosted the law’s enactment were fervent efforts from breast cancer advocates, saying patients need to be empowered with full knowledge of what their dense breast tissue may imply. As of today and since 2009, only 28 states have either passed, rejected, or considered a law mandating a notification regarding dense breast tissue.
The study also suggests that despite women being notified of their dense breast tissue, an alarming number of physicians do not know what to do with the assessment. This results in a reduced number of patients asking for more information about their breast density and what it signifies or could possibly entail.
To arrive at these findings, the study surveyed 77 physicians and their knowledge about the new California law. They found that nearly half were completely unaware of the new law, and only 32 percent observed any increase in their patients’ concern over their breast density. When it came to discussing this with their patients, the researchers found that most primary care physicians (55 percent) felt “somewhat comfortable,” and 12 percent felt uncomfortable.
Khong said that while their findings are alarming, they revealed many physicians do not feel they have been trained enough to make a confident recommendation for a method of secondary screening. The study revealed 75 percent of those surveyed would like additional education about the new law and its implications for primary care. He adds, “They are eager to learn and want to help their patients and be part of something positive as a result of this.”
Jonathan Hargreaves, assistant professor of clinical radiology and a study co-author, said, “The law has raised a lot of awareness about breast density. That being said, mammography screening is the primary thing patients need to do, and beyond that, the real benefits of other screening techniques are still the subject of ongoing medical debate.” The co-authors hope to confirm these results by expanding their study’s scope to include physicians from other university health care systems in the state.
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