The last Wednesday in September is World Dense Breast Day. The intention is to raise awareness about dense breast tissue and its potential health impacts. This matters—a lot—because an overwhelming majority of women are unaware of their breast density. Yet, nearly half of all women have dense breast tissue, and dense breast tissue makes abnormalities like cancer more difficult to see on a mammogram and indicates a woman’s increased risk of breast cancer.
In fact, the risk of breast cancer for women with extremely dense tissue is about five times greater than for those with low breast density. Sadly, despite all the progress made in the past few decades, breast cancer is still a leading cause of death for women in Santa Clara County.
But early detection of breast cancer can help save lives and reduce healthcare costs through treatments that can be less expensive and less burdensome to the patient.
This past March, the U.S. Food and Drug Administration issued a ruling establishing national standards that promote access to quality mammography services. This includes required notice to women with dense breast tissue to help them make better decisions about what medical screenings or care they may need—essentially what we did here in California more than a decade ago.
In 2012, as a state Senator, I authored Senate Bill 1538, which required that, following a mammogram, women are notified if they have dense breast tissue and of the range of screening options available to them.
I authored the bill after a constituent, Amy Colton, suggested the idea in my annual “There Oughta Be a Law” contest. Colton, a registered nurse, was shocked when she was told she had breast cancer after years of normal mammograms. She learned that she had dense breast tissue only after her cancer treatment.
Why is any of this timely? Because a year from now, a regulatory action will take effect, improving breast cancer screening in women with dense breast tissue. The new national noticing requirements will take effect no later than Sept. 10, 2024—appropriately, the same month in which World Dense Breast Day occurs—giving facilities time to come into compliance.
By requiring notice of dense breast tissue, the regulatory action will ensure that women in all 50 states are better informed about their bodies, and will help them make better decisions about the medical screening or care they might need.
A decade ago, some people thought my legislation was an implicit criticism of mammography. It was not. But we know that for a particular group of women—and a large group at that—mammography has its limitations. Mammographic sensitivity for breast cancer declines significantly with increasing breast density because both the cancer and the dense tissue appear white.
Fortunately, technology has come a long way. Digital breast tomosynthesis, currently used at about half of the nation’s health facilities, is quickly gaining in popularity and should be more widely accessible in the near future, including at more county facilities. For some women, depending on their breast density and cancer risk, MRI or ultrasound screening may be recommended.
That is why I also support the passage of the Find It Early Act, now pending in Congress. This federal legislation would require insurance plans to cover these diagnostic tests without additional cost to the patient due to insurance co-pays or deductibles.
While most plans cover mammograms, breast MRIs and ultrasounds are often more costly, forcing some women to skip these tests due to the additional out-of-pocket expenses. By requiring insurance companies to cover these treatments at no cost to the patient, fewer women will skip these additional screenings that might catch tumors missed by traditional mammograms, thereby potentially saving lives.
I am heartened by the fact we now have a nationwide standard, but I’m struck by the fact that it comes literally a decade after comprehensive breast tissue screening went into effect in California in April 2013.
I’m gratified that healthcare providers nationwide will soon be required to share this vital information with patients. I hope that those concerned about women’s health continue to do all they can to make women aware of this issue, to encourage them to ask the right questions about their cancer risk and to consider alternative screening possibilities, as well as other early detection and prevention measures.
For more information about dense breast tissue, visit www.areyoudense.org.
Santa Clara County Supervisor Joe Simitian represents the Fifth District, which includes Cupertino, Los Altos, Los Altos Hills, Los Gatos, Monte Sereno, Mountain View, Palo Alto, Saratoga, Stanford, portions of San Jose and unincorporated communities in the Santa Cruz Mountains. To signing for Simitian’s monthly newsletter, visit district5.sccgov.org/newsletter.