Digital Breast Tomosynthesis (DBT) and breast density have been in the news in Louisiana and Illinois, respectively, with legislative actions taken to improve the quality of breast imaging services in the two states.
In Louisiana, Gov. John Bel Edwards signed HB 460 into law. In the bill, the definition of "mammography examination" was expanded to include digital breast tomosynthesis, and "digital breast tomosynthesis" was defined as a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross-sectional digital three-dimensional images of the breast. The law goes into effect on January 1, 2019. States with DBT coverage mandate now include Arizona, Connecticut, Illinois, Kentucky, Louisiana, Maryland, Missouri, New Jersey, New York, Oklahoma, Pennsylvania, Texas, Vermont and Washington.
In Illinois, HB 4392 on breast density reporting was sent for the signature of Gov. Bruce Rauner on June 14. It requires health care providers to include the following notice in any summary of a mammography report sent to the patient, in accordance with the federal Mammography Quality Standards Act, after a mammogram demonstrating dense breast tissue:
"Your mammogram indicates you have dense breast tissue. Dense breast tissue is normal and identified on mammograms in about 50% of women. Dense breast tissue can make it more difficult to detect cancer on a mammogram and may be associated with an increased risk for breast cancer. Despite these limitations, screening mammograms have been proven to save lives. Continue to have routine screening mammography whether or not additional exams are suggested for you. This information is provided to raise your awareness of the impact of breast density on cancer detection. For further information about dense breast tissue, as well as other breast cancer risk factors, contact your breast imaging health care provider."
The bill allows facilities performing mammography to update the language in the specified notice to reflect advances in science and technology, as long as they continue to notify patients about dense breast tissue and its effect on the accuracy of mammograms. The notice must encourage patients to discuss the issue with their health care provider.