Physicians need more education about breast density and breast cancer screening, according to a study recently published in the Journal of Women’s Health. Jordonna Brown, M.B.B.S., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues survey local physicians (primary care providers [PCPs], radiologists, and gynecologists) regarding knowledge, attitudes, and practices for screening women with dense breasts.
More than 35 states have enact breast density inform laws with the intent to increase awareness of breast density as a limiting factor for mammographic sensitivity due to increases in the risk of interval cancers and to encourage patients to discuss the subject with their physicians.5,6 The statutes vary considerably with not all states mandating that an individual be given her own breast density assessment.
Patient with dense breasts
This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful; so base on your risk. A report of your results was send to your physician.
The New York law instructs patients to talk to ‘‘your physician’’ without defining; so who the physician should be, whether it is the ordering primary care provider (PCP) or, gynecologist or the radiologist. Consensus guidelines or recommendations for supplemental; so imaging of average-risk women with dense breasts are lacking.
Common questions about supplemental screening co-exist; hence with the perpetual debate about screening mammography guidelines; so should all women with dense breasts be offer supplemental screening and if so, when, how often, and by what method. Screening breast ultrasound (US) and magnetic resonance imaging (MRI) are the most commonly suggest supplemental imaging modalities.
Screening breast US is often the modality of choice give that it is more widely available; so has lower cost, and is widely acceptable by patients; but US has a lower sensitivity compare to MRI and is operator dependent. MRI currently requires a contrast injection and is generally more costly; so with few centers offering abbreviate less costly MRI protocols.
Primary care physicians
There were 155 respondents, including 75% female physicians, 77% attending-level physicians, 42% PCPs, 28% radiologists, 17% gynecologists, and 9% other providers. The researchers find that nearly half (48%) report being unaware of breast density laws; so while two-thirds (67%) felt they need more education about breast density and supplemental screening.
Sixty-two percent of respondents were unaware of the increase risk for breast cancer associate with dense breasts. PCPs were less aware of both their individual state’s breast density laws (odds ratio [OR], 0.21) and the increase breast cancer risk for women with dense breasts (OR, 0.23) compare with specialists.
Even after breast density inform laws have pass in over 30 states, PCPs are still unaware of their existence; also may not be fully ready to engage their patients in discussions about breast density and the associate risk of breast cancer. The primary goal of breast density laws to increase awareness of breast density has yet to be realize among primary care physicians. Further research about breast density associate risk for an individual woman; also evidence base protocols for screening dense breast women are need to help guide discussions between physicians and patients.