On April 1, 2013, California’s new breast density law takes effect, requiring health facilities that perform mammography to provide patients who have “heterogeneously dense breast or extremely dense breasts” with the following notice, in addition to the other findings of their mammogram:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer.

This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.”

The categorization of what constitutes dense breasts is based on the Breast Imaging Reporting and Data System established by the American College of Radiology and can be somewhat subjective.

The new law does not create a new duty of care or legal obligations beyond the duty of the health facility performing the mammography to provide the notice. The California Medical Association (CMA), however, remains concerned that such a notice places physicians in the position of counseling patients regarding breast density when there are no medical guidelines or scientific data to help interpret the report or to determine what, if any, additional testing should be done for patients with dense breast tissue.

While the intent of the law (SB 1538) is to give women more power and control over their health, CMA is concerned that it may impose undue cost burdens on the patient. Because high breast density is not currently by itself a risk factor for cancer in medical guidelines, in cases where prior authorization is required for additional screening, the tests may not be covered by their insurance.

If a patient inquires about breast density after receiving the mandated notification, physicians should provide patients with information regarding breast density and discuss their lifetime personal risk of breast cancer and appropriate screening and diagnostic tools specific to their needs. A brochure to help patients understand breast density is available on the American College of Radiology website at http://bit.ly/ACRDensityBrochure.

For more information, see CMA On-Call document #3112, “Cancer Information Requirements." This document, available in CMA’s online health law library, is available free to members in CMA's Health Law Library. Nonmembers can purchase this and other documents for $2 per page.

Physicians can find information and guidelines on breast density on the American College of Radiology website (www.acr.org) and the California Academy of Family Physicians website (www.familydocs.org/practice-management-news). More information on breast cancer screening can be found on the American Congress of Obstetricians and Gynecologists website (www.acog.org).

Contact: Scott Clark, (916) 551-2887 or sclark@cmadocs.org.