Advising Women About Supplemental Screening After Dense Breast Notification: Still No Easy AnswersAdvising Women About Screening After Dense Breast NotificationResearch
Menée aux Etats-Unis auprès d'une cohorte de 638 856 participantes (âge moyen : 56,5 ans) et à partir de l'analyse de 1 693 163 clichés de mammographies numériques, cette étude identifie les stratégies permettant, dans le cadre d'une mammographie de dépistage de routine, de déterminer, parmi les femmes à risque élevé de cancer du sein, celles pouvant bénéficier d'un entretien avec un médecin pour analyser la nécessité d'examens d'imagerie supplémentaires
Currently, 38 states have passed breast density notification laws. These laws vary by state, but generally require physicians to inform women when they are found to have dense breasts on mammography. Many state notifications also indicate that dense breasts can obscure abnormalities on a mammogram and are a risk factor for breast cancer. Some state laws specifically suggest a role for supplemental screening. More recently, the US Food and Drug Administration announced a proposed rule that would require all mammography reports in the United States to include such a notification. Under the proposed rule, all women would receive information about their own breast density as well as a notice encouraging them to discuss the findings with their physician. For women with dense breasts, the notification would also state, “Some patients with high breast density may need other imaging tests in addition to mammograms.” While well intentioned, these notifications strike many clinicians as blunt instruments. Breast density is only 1 aspect of breast cancer risk. Limiting discussions of supplemental screening to women with dense breasts may miss some high-risk women who do not have dense breasts, whereas many women with dense breasts may be at low risk overall. Could a more nuanced assessment of risk, beyond breast density, better identify women who are at high risk of a late-stage breast cancer diagnosis despite routine screening, and thus who might benefit from supplemental screening?
JAMA Internal Medicine , commentaire, 2018