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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2021

01-05-2021 | Ultrasound | Review

The impact of mandatory mammographic breast density notification on supplemental screening practice in the United States: a systematic review

Authors: Shuangqin Huang, Nehmat Houssami, Meagan Brennan, Brooke Nickel

Published in: Breast Cancer Research and Treatment | Issue 1/2021

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Abstract

Purpose

Dense breast tissue is an independent risk factor for breast cancer and lowers the sensitivity of screening mammography. Supplemental screening with ultrasound or MRI improves breast cancer detection rate but has potential harms. Breast density notification (BDN) legislation has been introduced in the United States (US) and its impact on supplemental screening practice is unclear. This study systematically reviewed current evidence to explore the impact of BDN on supplemental screening practice in the US.

Methods

Medline, PubMed, Embase, Cochrane and the Cinhal Library databases were searched (2009-August 2020). Studies were assessed for eligibility, data were extracted and summarised, and study quality was evaluated.

Results

Evidence from the included studies (n = 14) predominantly showed that BDN legislation increased the overall utilisation of supplemental screening by 0.5–143%. This effect was amplified if the notification included a follow-up telephone call informing women about additional screening benefits, and if the state’s law mandated insurance cover for supplemental screening. Likelihood of supplemental screening was also influenced by history of breast biopsy and family history of breast cancer, race, age, socioeconomic status, density category, and physician’s specialty and region. Some studies reported increases in biopsy rate (up to 4%) and cancer detection rate (up to 11%) after implementation of BDN legislation.

Conclusion

BDN leads to increased use of supplemental screening. This has implications for women and the health system. These findings can help inform current and future screening programs, where breast density notification is currently implemented or being considered.
Appendix
Available only for authorised users
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Metadata
Title
The impact of mandatory mammographic breast density notification on supplemental screening practice in the United States: a systematic review
Authors
Shuangqin Huang
Nehmat Houssami
Meagan Brennan
Brooke Nickel
Publication date
01-05-2021
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2021
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-021-06203-w

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