title: Dense breasts: a review of reporting legislation and available supplemental screening options.
abstract: OBJECTIVE
  The objectives of this article are to discuss the Mammography Quality Standards Act (MQSA) and what it means for patients, define breast density and explain how it is measured, review the new state-based legislation regarding the reporting of dense breast tissue directly to patients and the possibility of an adjunct screening examination, describe possible supplemental screening options and the advantages and disadvantages of each, and outline the current shortcomings and unanswered questions regarding new legislation.
  
  
  CONCLUSIONS
  Breast density is now established as an independent risk factor for developing breast cancer irrespective of other known risk factors. Women with breast density in the upper quartile have an associated four to five times greater risk of developing breast cancer relative to women with breast density in the lower quartile. Many states have enacted or proposed legislation requiring mammographers to report to patients directly if they have dense breast tissue and recommend discussing the possibility of a supplemental screening examination with their physicians. However, there is currently no consensus as to whether a supplemental screening examination should be pursued or which modality to use. Possible supplemental screening modalities include ultrasound, MRI, digital breast tomosynthesis, and molecular breast imaging. The U.S. Food and Drug Administration recently approved an automated breast ultrasound system for screening whole-breast ultrasound in patients with dense breasts. However, many questions are still unanswered including the impact on morbidity and mortality, cost-effectiveness, and insurance coverage.
authors: 1 Department of Radiology, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals and Ichan School of Medicine at Mount Sinai/St. Luke's-Roosevelt Program, 1000 Tenth Ave, Rm 4C-12, New York, NY 10019.
authors: Jessica M
authors: JM
authors: Ho
authors: Nasima
authors: N
authors: Jafferjee
authors: Gabriel M
authors: GM
authors: Covarrubias
authors: Munir
authors: M
authors: Ghesani
authors: Bradley
authors: B
authors: Handler
mesh_terms: D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000331:legislation & jurisprudence* / Q000592:standards*; D049268:Positron-Emission Tomography / Q000592:standards; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000592:standards; D016217:Ultrasonography, Mammary / Q000592:standards
keywords: breast cancer; breast density; legislation; screening; ultrasound