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DeHCA News

Density dominates breast imaging research

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Breast density notification laws are on the books in 24 states in the U.S., and a federal version is being developed. So it's not surprising that at this year's RSNA meeting, researchers explored not only how to take breast density into account when assessing a woman's risk and which modalities work best with dense tissue, but also questions such as whether the laws have affected radiologists' reporting and who is actually talking to women about breast density and supplemental screening.

One common theme on the clinical side was how automated volumetric software performs in analyzing breast tissue. Dr. Delia Keating at Memorial Sloan Kettering Cancer Center and colleagues compared radiologists' assessment of breast tissue density with that of an automated system. They found that automated breast density software tends to underreport breast density in a clinical setting.

A team led by Dr. Samantha Heller of NYU Langone Medical Center mapped density variation across a regional screening population using automated software, confirming that age impacts breast density, with older women generally having less dense tissue but also greater variability.

And Anna Starikov of NewYork-Presbyterian/Weill Cornell Medicine and colleagues compared conventional 2D mammography, digital breast tomosynthesis (DBT), and whole-breast ultrasound to determine which modalities work best for different breast densities. For women with dense breasts, 2D mammography plus DBT improves cancer detection, without the increased risk of false positives that adding ultrasound to 2D mammography can incur, they found.

On the practice side, researchers considered whether the laws have affected radiologists' reporting patterns -- and how women are actually getting information about their own breast density. A team led by Dr. Manisha Bahl of Duke University School of Medicine found that breast density notification laws seem to temporarily affect reporting patterns, with radiologists downgrading density assessments in the months after their state passed the legislation. Why? Perhaps because radiologists want to avoid the new reporting requirements, or because they fear their facilities could be overwhelmed by large numbers of women seeking supplemental screening, Bahl said.

Meanwhile, Dr. Shadi Aminololama-Shakeri of the University of California, Davis, and colleagues found that women are seeking information about their breast density and possible supplemental screening from the providers they often encounter first in their screening journey: technologists. But that doesn't let radiologists off the hook, she said: They still have a responsibility to educate women about breast density. In any case, research presented at RSNA 2015 made it clear that breast density as a risk factor -- and as a clinical challenge -- has become a key part of comprehensive women's breast health care.