California docs largely unaware of breast density law, uncomfortable with density discussions

Nearly a year after a breast density notification law took effect in California, the majority of physicians surveyed reported no knowledge of the legislation and were only “somewhat” comfortable with breast density questions, according to a study published online Dec. 24, 2014, in the Journal of the American College of Radiology.

Twenty states have enacted laws that mandate patient notification in cases of dense breast tissue, and according to the researchers, including Katherine A. Khong, MD, with the University of California, Davis, School of Medicine, more states are currently in the process of passing breast density legislation as well. National legislation is currently under review by Congress.

These laws require action on the part of the radiologists in the form of written notification and the authors claim this has little impact on actual patient care if the law is not clearly understood by primary physicians.

“Although radiologist compliance with the law is straightforward and presumably very high, the actual consequences for patients and primary physicians have not been studied,” Khong and colleagues wrote.

For the study, the researchers used a multiple-choice survey that was sent to 174 internal medicine, family medicine and obstetric-gynecology outpatient physicians.

The return rate of the survey was 45 percent (77 physicians). Of the responding physicians, 49 percent were not aware of the legislation before completing the survey.

Only 32 percent saw a change in the level of concern in their patients compared to prior years and the majority of respondents claimed to rarely answer patient questions concerning breast density after a mammography result letter.

Approximately 20 percent of responding physicians claimed to never answer breast density-related questions for patients.

Comfort level in answering patient questions about breast density was another metric studied in the survey and only 6 percent of responding physicians labeled themselves “completely comfortable” in doing so.

The survey also found that 75 percent of the responding physicians were interested in educational presentations about breast density and its impact on screening.

In light of the survey results, the researchers found that the law “has had less success in promoting discussions between patients and primary physicians than had been anticipated.”

They believe several factors have hindered these conversations, including:

• Patients with dense breasts may concentrate more on the mammography results than the breast density language in the results letters
• Patients who do understand the language may forget to discuss the density results at their next appointment
• High patient volumes
• Increased documentation requirements that lead to shorter healthcare visits
• Demands of staying current with scientific knowledge

“Our findings have implications for similar laws that are now under consideration, and for whether California’s law should be reauthorized after its sunset date in 2019,” Khong and colleagues concluded. “For such laws to have an impact on health practices, increased time and resources will need to be devoted to primary physician education, or institutions may need to consider alternative strategies for managing and assisting patients with issues related to breast density.”