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Iowa legislation mandates breast density notice


By Associated Press
Posted: February 1, 2014 - 5:15 am ET
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Iowa women who get mammogram examinations would receive information about their breast tissue density under bills being considered by lawmakers.

The bills would order Iowa's Department of Public Health to adopt rules that require breast density data be included in mammogram reports to patients and physicians. Dense breast tissue can make it harder for a mammogram to catch a possible tumor and may increase the risk of breast cancer.

Sen. Pam Jochum (D-Dubuque), who drafted a Senate bill, said the additional information would give women an extra sense of security.

"Mammograms don't take care of everything," Jochum said.

The legislation requires that mammography facilities provide a written statement to patients explaining that dense breast tissue is normal but can make it difficult to detect cancer on mammograms. Complete details about breast density would be included in the full mammography report sent to referring physicians.

Similar laws have been enacted in 14 states, with legislation being considered in several others.

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Dr. Nancy Cappello, founder of the advocacy group Are You Dense, said she is proof that mammograms don't always catch tumors. In 2004, Cappello was diagnosed with late stage breast cancer when a mammogram identified a metastasized tumor. Her doctors told her the dense tissue in her breasts hid the cancer for five years. This experience, she said, compelled her to organize a group to create awareness and promote early cancer detection.

"There are other women out there just like me," she said.

Dr. Barbara Monsees, chairwoman of the American College of Radiology commission on breast imaging, said dense breast tissue tends to mask cancer in mammograms, thus impairing a doctor's ability to identify tumors early on.

In some situations, especially if a woman is at high risk for developing breast cancer, screening with supplemental techniques such as breast MRI or ultrasound might be considered, she said.

The American College of Radiology recommends that breast density be included in mammography reports, but this is not mandated by the Food and Drug Administration, which regulates mammography.

Women with dense breasts may also have a higher risk of breast cancer compared to women with less dense breast tissue, according to the American Cancer Society.

Although doctors agree breast density is important, some in Iowa have opposed the proposed legislation.

Dr. Phil Colletier, president of the Polk County Medical Society, said he agrees that referring physicians receive notice of a patient's breast density, but providing a written notice directly to the patient would cause unnecessary anxiety.

"Only someone who has been on the receiving end of these letters would understand the extent of angst it puts on patients," he said.

He also said written notice could lead a patient to believe further testing is needed, meaning increased costs and the potential of false-positive readings in additional screenings.

"These aren't really good issues for the state to legislate," he said. "They're for the caretakers."

Dr. Victoria Sharp, president of the Iowa Medical Society, said lawmakers shouldn't tell doctors how to practice medicine.

"The practice of medicine shouldn't be a statute," she said. "We care for our patients to the best of our ability."

But Rep. Helen Miller (D-Fort Dodge), who brought forth a similar bill last year in the House and is continuing with it this session, said the issue must be looked at from a patient's perspective. When a person takes all the appropriate steps and finds out too late that cancer is present, something needs to be done, she said

"This is prevention with a capital P," Miller said. "It's just the right thing to do. What is the problem?"

Although Miller's bill stalled last year, Jochum said she's optimistic.

"I'm hoping it moves forward," Jochum said. "It's a good preventive measure."


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