167:(MQSA) already covers and regulates how mammography reports are handled and requires sending dense breast identification to physicians. But the law did not include notifying the patient; state-level laws have sought to account for this gap in regulation since 2009. A federal bill to expand the MQSA was presented to Congress in October of 2011, but was not passed. Subsequent federal bills were signed into law in February of 2019 and resulted in the FDA updating the MQSA to require reporting of mammograms to patients by all mammography facilities. The MQSA was amended again in 2023, requiring all patients to be notified of their breast density ("dense" or "not dense") in their mammogram reports as of September 10, 2024.
73:
Dense breast tissue is defined based on the amount of glandular and fibrous tissue as compared to the percentage of fatty tissue. The current mammography classifications split up the density of breasts into four categories. Approximately 10% of women have almost entirely fatty breasts, 40% with small
203:
The 2020 position statement from BreastScreen
Australia states that the "Standing Committee on Screening recommends that, until more evidence is available on how breast density is best assessed and managed (including evidence to support clinical pathways), BreastScreen Australia should not routinely
120:
Boyd suggested a new classification system that went beyond Wolfe's and titled his the Six Class
Categories (SCC) that split up breasts based on the percentage density of fibroglandular versus fatty tissue. A third classification system was suggested by Tabar et al. (2005) that took into account the
107:
of the breasts formed, the higher the correlative risk there was for developing breast cancer, with the densest examples seeing a 37-fold increased risk. His findings, however, were not replicable by other researchers and so his claims about the connection between dense breasts and a higher risk of
102:
The problem of dense breasts and mammography screenings was first identified by John Wolfe in 1976 where Wolfe laid out a new classification system based on the density of female breasts and the prominence of fibral duct tissue. He also noted that the higher the density of a woman's breasts and how
151:
The issues of diagnosing breast cancer for such affected women are required to be a part of the information given and the suggestion of additional testing using alternative methods. Most legislation also has any mammograms taken be given to the patient's physician and made a part of their medical
133:
Arguments against such legislation by some medical providers and physicians have been concerns that notification of such risks would result in women avoiding mammograms in fear of receiving a breast cancer diagnosis. Yeh et al. (2015) found that notifying women resulted in an overall increase in
116:
and the risk of the women developing cancer over time based on the density of their breasts. He found on the extreme ends that women with a high breast density developed cancer at a rate five times higher than those with almost entirely fatty breast tissue. It has also been suggested by some
111:
While it was agreed that the "masking effect" impact of dense breasts on conducting mammograms made it difficult to identify developing breast cancer, it was not until a 2007 publication by Norman Boyd that a replication of Wolfe's work was shown. Boyd compared a wide variety of
129:
The creation of legislation related to dense breasts has focused on requiring the notification of women by their medical provider that they have dense breasts after this is diagnosed during mammograms, along with improving general awareness of the condition among the public.
74:
pockets of dense tissue, 40% with even distribution of dense tissue throughout, and 10% with extremely dense tissue. The latter two groups are those included under the definition of dense breasts. These categories were officially determined as a part of the
204:
record breast density or provide supplemental testing for women with dense breasts." As of 2023, women in South
Australia will be informed of their breast density after a study showed they strongly preferred to be informed of this information.
170:
Research in 2021 by
Kressin et al. on the impact of the state and federal laws regarding dense breasts found that notification laws increased the likelihood of women being informed about dense breasts by 1.5 times, but women who were
175:(POC) and particularly those with lower incomes were less likely to be informed by their physicians than non-POC who were in wealthier income brackets. This included being informed of the higher risk of developing breast cancer.
89:
dark areas representing fatty tissue and the radioopaque bright spots representing combined fibroglandular tissue. Assessing the new growth of a tumor as a bright spot is the primary method radiologists use to identify
195:, published a recommendation that women be informed at screenings of their breast density, as well as recommending MRI screening every two to four years for those between 50 and 70 with extremely dense breast tissue.
134:
intention of the informed individuals to have future ultrasounds and other testing to account for the higher potential risk of developing breast cancer. However, the authors noted that women with a high level of
897:
Mann RM, Athanasiou A, Baltzer PA, Camps-Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Killburn-Toppin F, Lesaru M, Panizza P, Pediconi F, Pijnappel RM, Pinker K (June 2022).
183:
As of 2023, most provinces require notification of breast density level; some regions such as Quebec, the
Northwest Territories, and Yukon record the data but do not automatically inform patients.
156:, who had been diagnosed with stage 3 cancer owing to the failure of mammograms to detect the growing tumor. Other states have passed their own legislation, with Texas, for example, passing
65:
in women with dense breast tissue. Additionally, women with such tissue have a higher likelihood of developing breast cancer in general, though the reasons for this are poorly understood.
622:
760:
94:. However, women with dense breasts have an overall white coloration referred to as the "masking effect" that prevents the identification of new bright spots in the tissue.
1173:
957:
820:
511:
463:
313:
283:
1032:
366:
227:
138:
were less likely to desire future mammograms and this was especially true for women where ultrasounds were not covered by their health insurance.
1362:
1166:
988:
429:
152:
record. The first state legislation on dense breast notifications was passed in 2009 in
Connecticut after advocacy by breast cancer survivor
630:
965:
565:"The Divide Between Breast Density Notification Laws and Evidence-Based Guidelines for Breast Cancer Screening: Legislating Practice"
164:
900:"Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)"
117:
researchers, such as in Byrne et al. (1995), that breast density is the greatest risk factor to the development of breast cancer.
1159:
989:"From 8 August, South Australian women will be informed of their individual breast density at their BreastScreen SA mammograms!"
788:
507:"Dense breast tissue notification: impact on women's perceived risk, anxiety, and intentions for future breast cancer screening"
121:
percentage of all three types of tissue and the linear density and defined six groups based on all four percentages at once.
192:
75:
1434:
1025:
221:
Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, Kerlikowske K, Miglioretti DL (October 2014).
1266:
53:. Around 40–50% of women have dense breast tissue and one of the main medical components of the condition is that
1429:
564:
1424:
1018:
765:
113:
1261:
1206:
569:
458:
816:"Dense Breast Notification Laws' Association With Outcomes in the US Population: A Cross-Sectional Study"
1201:
1068:
46:
709:
Henderson LM, Marsh MW, Earnhardt K, Pritchard M, Benefield TS, Agans RP, Lee SS (December 15, 2020).
1326:
361:
318:
85:
When undergoing a mammogram, tissue density is differentiated with bright and dark spots, with the
1256:
1251:
1211:
1119:
1109:
360:
Byrne C, Schairer C, Wolfe J, Parekh N, Salane M, Brinton LA, Hoover R, Haile R (November 1995).
275:
135:
91:
1104:
939:
921:
847:
815:
742:
691:
673:
596:
538:
506:
480:
425:
383:
335:
254:
1393:
1314:
1097:
1090:
1085:
929:
911:
837:
829:
732:
724:
715:
681:
665:
586:
578:
528:
520:
472:
417:
375:
362:"Mammographic Features and Breast Cancer Risk: Effects With Time, Age, and Menopause Status"
327:
244:
236:
42:
1419:
1347:
1309:
172:
654:"Impact of Henda's Law on the Utilization of Screening Breast Magnetic Resonance Imaging"
409:
1398:
1304:
1246:
1182:
1073:
934:
899:
842:
737:
710:
686:
653:
591:
533:
249:
222:
157:
153:
50:
410:"Comparison Between Wolfe, Boyd, BI-RADS and Tabár Based Mammographic Risk Assessment"
1413:
1140:
1080:
1061:
711:"Understanding the response of mammography facilities to breast density notification"
160:
in 2011. By 2015, 19 states had legal notification statutes for dense breast tissue.
62:
582:
1383:
1319:
1278:
669:
331:
1388:
1357:
1352:
1342:
1288:
1283:
1241:
1231:
86:
61:
from the surrounding dense tissue. This increases the risk of late diagnosis of
916:
833:
524:
476:
379:
104:
54:
925:
677:
17:
943:
851:
746:
695:
600:
542:
484:
339:
258:
387:
240:
1196:
814:
Kreessin NR, Battalglia TA, Wormwood JB, Slanetz PJ, Gunn CM (May 2021).
58:
1010:
421:
1236:
728:
416:. Lecture Notes in Computer Science. Vol. 4046. pp. 407–415.
408:
Muhimmah I, Oliver A, Denton ER, Pont J, Perez E, Zwiggelaar R (2006).
79:
38:
1378:
1114:
1056:
1042:
872:
459:"Dense Breast Legislation in the United States: State of the States"
223:"Prevalence of Mammographically Dense Breasts in the United States"
1151:
1155:
1014:
652:
Mason C, Yokubaitis K, Howard E, Shah Z, Wang J (2015-01-01).
623:"Governor signs 'Henda's Law', the work of Lakewood neighbor"
191:
In 2022, the
European Society of Breast Imaging, part of the
505:
Yeh VM, Schnur JB, Margolies L, Montgomery GH (March 2015).
966:
Australian
Government: Department of Health and Aged Care
41:
where a higher proportion of the breasts are made up of
958:"Breast density and screening: 2020 position statement"
314:"Mammographic breast density: from Wolfe and beyond"
1371:
1335:
1297:
1222:
1189:
1128:
1049:
108:cancer were dismissed by the radiology community.
789:"Mammography Quality Standards Act and Program"
452:
450:
448:
307:
305:
303:
301:
1167:
1026:
78:'s Breast Imaging Reporting and Data System (
8:
1232:Adipomastia (lipomastia, pseudogynecomastia)
821:Journal of the American College of Radiology
658:Baylor University Medical Center Proceedings
512:Journal of the American College of Radiology
464:Journal of the American College of Radiology
1174:
1160:
1152:
1033:
1019:
1011:
761:"Breast Density and Your Mammogram Report"
284:Centers for Disease Control and Prevention
276:"What Does It Mean to Have Dense Breasts?"
933:
915:
841:
736:
685:
590:
532:
248:
457:Dehkordy SF, Carlos RC (November 2016).
367:Journal of the National Cancer Institute
228:Journal of the National Cancer Institute
213:
1363:Pseudoangiomatous stromal hyperplasia
563:Haas JS, Kaplan CP (September 2015).
270:
268:
7:
1062:Areolar gland (gland of Montgomery)
25:
993:Australian Breast Cancer Research
165:Mammography Quality Standards Act
583:10.1001/jamainternmed.2015.3040
969:. BreastScreen Australia. 2020
670:10.1080/08998280.2015.11929171
312:Rafferty EA (September 2014).
1:
193:European Society of Radiology
76:American College of Radiology
332:10.1097/GME.0000000000000308
57:are unable to differentiate
1451:
917:10.1007/s00330-022-08617-6
834:10.1016/j.jacr.2020.11.012
525:10.1016/j.jacr.2014.11.001
477:10.1016/j.jacr.2016.09.027
27:Condition of human breasts
621:Stone R (June 22, 2011).
163:A federal law titled the
37:, is a condition of the
1267:Chronic cystic mastitis
766:American Cancer Society
380:10.1093/jnci/87.21.1622
1262:Duct ectasia of breast
1207:Granulomatous mastitis
570:JAMA Internal Medicine
1223:Physiological changes
1202:Nonpuerperal mastitis
877:Dense Breasts Canada
633:on November 11, 2019
286:. September 22, 2021
1435:Medical terminology
1327:Nipple pigmentation
1274:Dense breast tissue
1136:Dense breast tissue
422:10.1007/11783237_55
414:Digital Mammography
241:10.1093/jnci/dju255
103:the pattern of the
31:Dense breast tissue
1257:Breast hypertrophy
1252:Breast engorgement
1212:Subareolar abscess
1120:Retromammary space
1110:Intermammary cleft
1069:Cooper's ligaments
904:European Radiology
795:. December 1, 2023
729:10.1002/cncr.33198
136:ambiguity aversion
105:parenchymal tissue
92:early-stage cancer
1407:
1406:
1149:
1148:
1105:Inframammary fold
723:(24): 5230–5238.
431:978-3-540-35625-7
374:(21): 1622–1629.
16:(Redirected from
1442:
1430:Cancer screening
1315:Nipple discharge
1176:
1169:
1162:
1153:
1098:Mammary alveolus
1091:Terminal end bud
1086:Lactiferous duct
1035:
1028:
1021:
1012:
1005:
1004:
1002:
1000:
985:
979:
978:
976:
974:
962:
954:
948:
947:
937:
919:
910:(6): 4036–4045.
894:
888:
887:
885:
883:
869:
863:
862:
860:
858:
845:
811:
805:
804:
802:
800:
785:
779:
778:
776:
774:
757:
751:
750:
740:
706:
700:
699:
689:
649:
643:
642:
640:
638:
629:. Archived from
618:
612:
611:
609:
607:
594:
577:(9): 1439–1440.
560:
554:
553:
551:
549:
536:
502:
496:
495:
493:
491:
454:
443:
442:
440:
438:
405:
399:
398:
396:
394:
357:
351:
350:
348:
346:
309:
296:
295:
293:
291:
272:
263:
262:
252:
218:
43:glandular tissue
33:, also known as
21:
1450:
1449:
1445:
1444:
1443:
1441:
1440:
1439:
1410:
1409:
1408:
1403:
1367:
1348:Breast hematoma
1331:
1310:Inverted nipple
1305:Cracked nipples
1293:
1224:
1218:
1185:
1180:
1150:
1145:
1124:
1045:
1041:Anatomy of the
1039:
1009:
1008:
998:
996:
995:. July 31, 2023
987:
986:
982:
972:
970:
960:
956:
955:
951:
896:
895:
891:
881:
879:
871:
870:
866:
856:
854:
813:
812:
808:
798:
796:
787:
786:
782:
772:
770:
769:. March 8, 2023
759:
758:
754:
708:
707:
703:
651:
650:
646:
636:
634:
620:
619:
615:
605:
603:
562:
561:
557:
547:
545:
504:
503:
499:
489:
487:
456:
455:
446:
436:
434:
432:
407:
406:
402:
392:
390:
359:
358:
354:
344:
342:
311:
310:
299:
289:
287:
274:
273:
266:
220:
219:
215:
210:
201:
189:
181:
173:people of color
149:
144:
127:
100:
71:
59:tumorous tissue
28:
23:
22:
15:
12:
11:
5:
1448:
1446:
1438:
1437:
1432:
1427:
1425:Breast imaging
1422:
1412:
1411:
1405:
1404:
1402:
1401:
1396:
1391:
1386:
1381:
1375:
1373:
1369:
1368:
1366:
1365:
1360:
1355:
1350:
1345:
1339:
1337:
1333:
1332:
1330:
1329:
1324:
1323:
1322:
1312:
1307:
1301:
1299:
1295:
1294:
1292:
1291:
1286:
1281:
1276:
1271:
1270:
1269:
1264:
1254:
1249:
1247:Breast atrophy
1244:
1239:
1234:
1228:
1226:
1225:and conditions
1220:
1219:
1217:
1216:
1215:
1214:
1209:
1199:
1193:
1191:
1187:
1186:
1183:Breast disease
1181:
1179:
1178:
1171:
1164:
1156:
1147:
1146:
1144:
1143:
1138:
1132:
1130:
1126:
1125:
1123:
1122:
1117:
1112:
1107:
1102:
1101:
1100:
1095:
1094:
1093:
1078:
1077:
1076:
1074:Tail of Spence
1066:
1065:
1064:
1053:
1051:
1047:
1046:
1040:
1038:
1037:
1030:
1023:
1015:
1007:
1006:
980:
949:
889:
873:"Get Informed"
864:
828:(5): 685–695.
806:
780:
752:
701:
644:
613:
555:
519:(3): 261–266.
497:
444:
430:
400:
352:
326:(9): 920–921.
297:
264:
212:
211:
209:
206:
200:
197:
188:
185:
180:
177:
154:Nancy Cappello
148:
145:
143:
140:
126:
123:
99:
96:
70:
67:
47:fibrous tissue
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
1447:
1436:
1433:
1431:
1428:
1426:
1423:
1421:
1418:
1417:
1415:
1400:
1397:
1395:
1392:
1390:
1387:
1385:
1382:
1380:
1377:
1376:
1374:
1370:
1364:
1361:
1359:
1356:
1354:
1351:
1349:
1346:
1344:
1341:
1340:
1338:
1334:
1328:
1325:
1321:
1318:
1317:
1316:
1313:
1311:
1308:
1306:
1303:
1302:
1300:
1296:
1290:
1287:
1285:
1282:
1280:
1277:
1275:
1272:
1268:
1265:
1263:
1260:
1259:
1258:
1255:
1253:
1250:
1248:
1245:
1243:
1240:
1238:
1235:
1233:
1230:
1229:
1227:
1221:
1213:
1210:
1208:
1205:
1204:
1203:
1200:
1198:
1195:
1194:
1192:
1188:
1184:
1177:
1172:
1170:
1165:
1163:
1158:
1157:
1154:
1142:
1141:Mammary ridge
1139:
1137:
1134:
1133:
1131:
1127:
1121:
1118:
1116:
1113:
1111:
1108:
1106:
1103:
1099:
1096:
1092:
1089:
1088:
1087:
1084:
1083:
1082:
1081:Mammary gland
1079:
1075:
1072:
1071:
1070:
1067:
1063:
1060:
1059:
1058:
1055:
1054:
1052:
1048:
1044:
1036:
1031:
1029:
1024:
1022:
1017:
1016:
1013:
994:
990:
984:
981:
968:
967:
959:
953:
950:
945:
941:
936:
931:
927:
923:
918:
913:
909:
905:
901:
893:
890:
878:
874:
868:
865:
853:
849:
844:
839:
835:
831:
827:
823:
822:
817:
810:
807:
794:
790:
784:
781:
768:
767:
762:
756:
753:
748:
744:
739:
734:
730:
726:
722:
718:
717:
712:
705:
702:
697:
693:
688:
683:
679:
675:
671:
667:
663:
659:
655:
648:
645:
632:
628:
624:
617:
614:
602:
598:
593:
588:
584:
580:
576:
572:
571:
566:
559:
556:
544:
540:
535:
530:
526:
522:
518:
514:
513:
508:
501:
498:
486:
482:
478:
474:
471:(11): 53–57.
470:
466:
465:
460:
453:
451:
449:
445:
433:
427:
423:
419:
415:
411:
404:
401:
389:
385:
381:
377:
373:
369:
368:
363:
356:
353:
341:
337:
333:
329:
325:
321:
320:
315:
308:
306:
304:
302:
298:
285:
281:
277:
271:
269:
265:
260:
256:
251:
246:
242:
238:
234:
230:
229:
224:
217:
214:
207:
205:
198:
196:
194:
186:
184:
178:
176:
174:
168:
166:
161:
159:
155:
147:United States
146:
142:North America
141:
139:
137:
131:
124:
122:
118:
115:
114:case controls
109:
106:
97:
95:
93:
88:
83:
81:
77:
68:
66:
64:
63:breast cancer
60:
56:
52:
48:
44:
40:
36:
35:dense breasts
32:
19:
18:Dense breasts
1384:Fat necrosis
1320:Galactorrhea
1279:Gynecomastia
1273:
1190:Inflammation
1135:
999:December 13,
997:. Retrieved
992:
983:
973:December 13,
971:. Retrieved
964:
952:
907:
903:
892:
882:December 13,
880:. Retrieved
876:
867:
855:. Retrieved
825:
819:
809:
799:December 13,
797:. Retrieved
792:
783:
773:December 13,
771:. Retrieved
764:
755:
720:
714:
704:
661:
657:
647:
637:February 10,
635:. Retrieved
631:the original
626:
616:
604:. Retrieved
574:
568:
558:
546:. Retrieved
516:
510:
500:
488:. Retrieved
468:
462:
435:. Retrieved
413:
403:
391:. Retrieved
371:
365:
355:
343:. Retrieved
323:
317:
288:. Retrieved
279:
232:
226:
216:
202:
190:
182:
169:
162:
150:
132:
128:
119:
110:
101:
84:
72:
51:fatty tissue
34:
30:
29:
1358:Galactocele
1353:Breast lump
1343:Breast cyst
1289:Micromastia
1284:Mammoplasia
1242:Anisomastia
857:October 29,
606:October 29,
548:October 29,
490:October 29,
437:October 29,
393:October 29,
345:October 29,
290:October 29,
235:(10): 255.
158:Henda's Law
125:Legislation
87:radiolucent
1414:Categories
664:(1): 7–9.
208:References
69:Definition
55:mammograms
1050:Structure
926:1432-1084
678:0899-8280
319:Menopause
199:Australia
1197:Mastitis
944:35258677
852:33358722
747:32926413
696:25552785
627:Advocate
601:26147642
543:25556313
485:27814815
340:25072956
259:25217577
1399:Tension
1237:Amastia
935:9122856
843:8106616
738:7944399
687:4264697
592:4564307
534:4352389
388:7563205
280:cdc.gov
250:4200066
98:History
80:BI-RADS
39:breasts
1420:Breast
1394:Ptosis
1379:Amazia
1336:Masses
1298:Nipple
1115:Nipple
1057:Areola
1043:breast
942:
932:
924:
850:
840:
745:
735:
716:Cancer
694:
684:
676:
599:
589:
541:
531:
483:
428:
386:
338:
257:
247:
187:Europe
179:Canada
1372:Other
1129:Other
961:(PDF)
49:than
1389:Pain
1001:2023
975:2023
940:PMID
922:ISSN
884:2023
859:2021
848:PMID
801:2023
775:2023
743:PMID
692:PMID
674:ISSN
639:2020
608:2021
597:PMID
550:2021
539:PMID
492:2021
481:PMID
439:2021
426:ISBN
395:2021
384:PMID
347:2021
336:PMID
292:2021
255:PMID
45:and
930:PMC
912:doi
838:PMC
830:doi
793:FDA
733:PMC
725:doi
721:126
682:PMC
666:doi
587:PMC
579:doi
575:175
529:PMC
521:doi
473:doi
418:doi
376:doi
328:doi
245:PMC
237:doi
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