September 10, 2024, marked a historic shift in women’s healthcare when the first federal breast density notification and reporting mandate went into effect. This means that now, all women in the United States will be informed by their providers about whether they have dense breast tissue after a mammogram.
While this law helps to inform women about their risks, it is just the beginning. We need to ensure that women can do something with this important information without facing financial or logistical roadblocks.
Today, on World Dense Breast Day, it would serve us well to remember that while the law put into effect a couple of weeks ago provides knowledge, we must do much more to empower women with the tools, coverage, and access necessary to protect their health.
What Does Dense Breast Tissue Have To Do With Early Detection?
For many, breast density is an unfamiliar concept, but it is an issue that affects between 40% and 50% of women. Dense breast tissue, which consists of more connective and glandular tissue compared to fat, not only increases a woman’s risk of developing breast cancer by five to six times but also makes it harder to detect cancer with mammography alone. [1]
In a mammogram, dense tissue and cancerous tumors both appear white, which can make malignancies harder to identify. This is why traditional mammograms are significantly less effective for women with dense breasts—detecting cancer only about 56% of the time. In comparison, mammograms are around 85% effective for women with non-dense breasts. However, when mammograms are combined with supplemental imaging like ultrasound or MRI, the detection rate jumps to 88% and even higher for MRI screenings.
While these statistics demonstrate the importance of the new federal breast density notification law, which allows women to have more informed discussions with their doctors, the question remains: What comes next?
Access To Supplemental Screenings – A Necessity
While the new law guarantees that women will be informed of their breast density status, it does not provide a solution for what happens after they receive that information. There is currently no federal requirement for insurance companies to cover supplemental screenings like ultrasounds or MRIs, which are critical for women with dense breasts. Without coverage, many women—especially those with limited financial means—may not be able to afford these life-saving tests.
I often hear from women who, after learning they have dense breasts, are left in a difficult position. They know they need additional imaging, but the cost can be astronomical. In some states, insurance does cover these screenings, but coverage is inconsistent across the country. Thirty-three states, plus Washington D.C., have passed laws requiring insurance coverage for supplemental screening, but even these laws have loopholes. In other states, there is no such coverage at all. This inconsistency leaves millions of women vulnerable, even though they have the information they need to make a more informed choice about their health.
Why The Find It Early Act Matters
Breast cancer advocates from across the United States are pushing for the passage of the Find It Early Act. This federal legislation would require all insurance providers to cover supplemental screenings like ultrasound and MRI for women with dense breasts or other risk factors for breast cancer.
Peter Eby, MD, Division Chief of Breast Radiology at Penn Medicine, recently estimated that the economic cost of losing a woman in her 40s to breast cancer is estimated at $1.4 million. This number includes the financial loss to the economy and the profound impact on her family and community. While you can’t put a dollar amount on a saved life, access to screenings that lead to early detection provides indisputable economic value.
A breast cancer diagnosis does not just affect the individual; it ripples out to their children, spouses, and loved ones. By detecting breast cancer early—when it is most treatable—we can prevent families from enduring the devastating loss of a loved one.
AI & Early Detection
At Volpara, we have spent almost 20 years developing AI-based solutions to improve breast cancer detection for women with dense breast tissue. We work with clinicians, researchers, and advocates to address the gaps in detection. Our AI-driven tools, such as Volpara TruDensity®, help radiologists consistently and accurately measure breast density in a way that is objective, not subjective.
Studies like the DENSE trial have shown that adding MRI to the screening process for women with dense breasts significantly increases the detection rate of cancers that mammography alone would miss. Volumetric density assessments, like the ones given by Volpara, go beyond the basic BI-RADS categories, offering a more personalized understanding of each woman’s risk level. AI and machine learning tools like these will play an increasingly important role in breast cancer detection moving forward. But, once again, for these tools to be effective, every woman—regardless of her zip code or her financial situation—must have access to the screenings and technologies that can save her life.
What’s Ahead
The Find It Early Act is a necessary next step to close the gap between knowing you have dense breasts and being able to do something about it. Together, we can create a future where no woman dies because her breast cancer was not caught in time—because she could not afford the screenings she needed.
I am incredibly grateful for the support from champions like Rep. Rosa DeLauro and the bipartisan coalition working to pass the Find It Early Act. However, we need to keep pushing for progress. Let us acknowledge World Dense Breast Day and celebrate recent advancements, yes, but not become complacent.
While the new federal breast density notification law helps to better inform women about their health, information alone, without access, does not save lives.
Reference
[1] Sattin RW, Rubin GL, Webster LA, Huezo CM, Wingo PA, Ory HW, Layde PM. Family history and the risk of breast cancer. JAMA. 1985 Apr 5;253(13):1908-13. PMID: 3974080.
[2] Bakker MF, de Lange SV, Pijnappel RM, Mann RM, Peeters PHM, Monninkhof EM, Emaus MJ, Loo CE, Bisschops RHC, Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, Mali WPTM, van den Bosch MAAJ, Veldhuis WB, van Gils CH; DENSE Trial Study Group. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019 Nov 28;381(22):2091-2102. doi: 10.1056/NEJMoa1903986. PMID: 31774954.
[3] Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung JWT, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol. 2021 Sep;18(9):1280-1288. doi: 10.1016/j.jacr.2021.04.021. Epub 2021 Jun 19. PMID: 34154984.
Featured image: © 2016 – 2024 Unsplash licenses. Used with permission
DOI: 10.14229/onco.2024.09.25.001
Op-Ed by Teri Thomas, CEO of Volpara Health
