Breast Density and New Jersey Legislation
Presentation based upon and reproduced with the
permission of the California Breast Density Information
Group (CBDIG) Scenarios for clinicians, March 2013.
What is the New Jersey breast density legislation?
law, effective May 1st 2014, that mandates that
radiologists include the follow comment on all lay
letters mailed to patients after their screening
“Your mammogram may show that you have dense breast
tissue as determined by the Breast Imaging Reporting and
Data System established by the American College of
Radiology. Dense breast tissue is very common and is not
abnormal. However, in some cases, dense breast tissue
can make it harder to find cancer on a mammogram and may
also be associated with a risk factor for breast cancer.
Discuss this and other risks for breast cancer that
pertain to your personal medical history with your
healthcare provider. A report of your results was sent
to your healthcare provider. You may also find more
information about breast density at the website for the
American College of Radiology,
My patient received her screening mammogram lay letter.
Now she is concerned about her breast density. Her first
question is “Should I continue to have mammograms?”
All patients should continue to have annual screening
mammograms. Mammograms have been shown to be effective
in decreasing breast cancer mortality for all breast
My patient is concerned that her breast density places
her at increased risk for breast cancer.
Reassure your patient that breast density alone has a
small impact on the risk for breast cancer. More
importantly, they are not at increased risk of dying
from breast cancer when compared to women with fatty
My patient asks “How dense are my breasts?”
Refer to the mammogram report (different from the lay
letter). There are four classifications of breast
density (A,B,C,D). This is determined subjectively by
the interpreting radiologist.
Almost entirely fatty
Scattered areas of fibroglandular densities
Minimal increased risk above average (RR=1.2
compared to average breast density)
Doubles the risk of breast cancer compared to
average density. This increase in risk is similar to
the risk associated with a family history of
unilateral, postmenopausal breast cancer in a
mother, sister or daughter.
My patient does NOT have dense breasts but she still
wants additional breast screening studies.
Assure the patient that she is not at increased risk for
breast cancer and that annual screening mammography is
the current best screening method for breast cancer for
women of all breast densities.
supplemental screening studies exist (MRI, ultrasound,
tomosynthesis) but will likely not be covered by
insurance for patients that do not have dense breasts.
My patient has dense breasts. Should she be screened
with something different than mammography?
Explain that at this point, there is no other method
recommended to replace mammography. There are certain
signs of cancer (for example, calcifications) that are
best seen on a mammogram. Other “screening” options are
not meant to replace mammography. These studies are done
as a supplement.
What role does tomosynthesis play in breast cancer
Tomosynthesis is an emerging imaging modality that has
shown promise in early clinical trials. Its role in
breast cancer screening is currently being evaluated.
My patient has dense breasts and she wants to get
additional screening tests.
My patient is in a high risk category. She has at least
one of the following:
Calculated >20% lifetime risk (as based upon a risk
Calculated >5% 10 year risk of breast cancer (as
based upon a risk model)
History of mantle radiation at 30 years of age or
annual screening mammogram and annual screening breast
MRI. Screening MRI is typically covered by insurance for
high risk women. If a woman is being screening
annually with a mammogram and MRI, no additional tests
(such as ultrasound) are needed.
My patient meets criteria of a high risk patient. I
recommended continuing annual screening mammography and
adding annual screening MRI. However, my patient is
unable to have an MRI (claustrophobia, pacemaker,
contrast allergy, or other reasons).
annual screening mammogram and annual screening
ultrasound, as the second best supplementary screening
test for high risk women. Studies have shown some
utility for ultrasound in high risk women if
screening MRI is not performed.
you. We hope that this clarifies your concerns about