Educational materials developed by the American College of Radiology (ACR) and individual chapters are assisting radiologists and referring physicians in meeting requirements of breast density notification laws in a growing number of states.

As of September 2013, 13 states had laws on the books requiring mandatory breast density notification or inclusion of awareness provisions in lay letters to patients. The states are Alabama, California, Connecticut, Hawaii, Indiana, Maryland, New York, North Carolina, Nevada, Oregon, Tennessee, Texas and Virginia.

In Utah, notification is optional. In Maine, physicians voluntarily agreed to abide by the recommendations of a designated provider-patient work group to include breast density information in the letters to patients without a legislative mandate.

Most recently, Illinois Gov. Pat Quinn signed a bill into law instructing the Department of Public Health to create a summary about breast cancer that will inform individuals in layman's terms of the meaning and consequences of "dense breast tissue" under the guidelines of the Breast Imaging Reporting and Data Systems (BI-RADS®) of the ACR.

States with legislation still pending in the 2013 session include Massachusetts, Michigan, New Jersey, Michigan, New Jersey, Ohio and Pennsylvania. Additional states may file similar legislation in 2014 session.

In a statement on breast density reporting, published in April 2012, the ACR recognizes that breast density has an impact on mammographic screening and delineates that greater breast density results in lower sensitivity for mammography. The College’s BI-RADS — Mammography lexicon describes four categories of breast parenchymal density and instructs radiologists to include density information in the mammography report for the referring physicians.

Federal Mammography Quality Standards Act (MQSA) includes a requirement for patient notification through summary letters. Many of the new state laws on breast density notification take this process a step further by requiring the mammography facilities to include statutorily mandated language within patient lay letters.

The ACR recommends several resources dedicated to the subject of breast density to its members and referring physicians. The Breast Imaging Resources page of the ACR website and the Mammography Saves Lives website feature an informational brochure designed for patient education that facilities have the option of including with letters for every patient getting a mammogram irrespective of individual breast density finding. The tri-fold brochure was developed by the ACR and the Society of Breast Imaging. The information in the patient brochure is factual, with advice based on peer-reviewed clinical research.

Additionally, the ACR has updated its Sample Mammography Lay Report Letters to include optional language for providers to include in letters to patients following dense breast tissue finding on the results of a mammogram.

Helpful advice is also available at, a website developed by the California Breast Density Information Group, a working group of breast radiologists and breast cancer risk specialists from six medical schools and two high-volume mammography services in California.

The website features flow charts illustrating six clinical scenarios that physicians will probably encounter while complying with the law in California. Patients pose specific questions, such as whether mammograms are still necessary for women with dense breasts. The charts recommend specific physician responses to many of the frequently asked questions.