title: Impact of the new density reporting laws: radiologist perceptions and actual behavior.
abstract: OBJECTIVE
  To assess radiologists' perceptions of how the new Breast Density Notification Act (BDNA) of Pennsylvania would affect their breast density reporting and their actual reporting patterns after implementation.
  
  
  METHODS
  Under an institutional review board-approved protocol, we surveyed 21 radiologists about how they believe the new law affected their breast density reporting patterns and analyzed actual changes for 16 respondents before and after the law took effect. Three hundred consecutive reports were assessed for each radiologist before and after the effective date. The distributions of reported density Breast Imaging Reporting and Data System (BI-RADS) (1-4) were compared using a type III test in the context of an ordinal mixed model accounting for between-reader variability and adjusting for age (PROC GLIMMIX, SAS, version 9.3) using a two-sided .05 significance level.
  
  
  RESULTS
  Seventeen radiologists responded to the survey; however, one retired shortly after responding. Of the 16 respondents, 56% (nine of 16) did not favor the law, 13% (two of 16) were in favor, and 31% (five of 16) were neutral. The fraction perceived that after implementation, they rated more, equally, or less frequently breasts as scattered fibroglandular densities (BI-RADS 2) versus heterogeneously dense rating (BI-RADS 3) was 50% (eight of 16), 44% (seven of 16), and 6% (one of 16), respectively. In practice, 44% (seven of 16) performed differently than their survey answers. Fourteen of 16 radiologists increased the frequency of reported BI-RADS 2 scores after BDNA implementation with seven having statistically significant (P < .05) increases after adjusting for age differences.
  
  
  CONCLUSIONS
  Radiologists' reporting patterns changed, at least for a short duration, after the new density reporting law and for some of the radiologists in an unexpected way.
authors.affiliation: Department of Radiology, Imaging Research, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213. Electronic address: gurd@upmc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Gur
authors.affiliation: Department of Radiology, Imaging Research, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Klym
authors.affiliation: Department of Radiology, Imaging Research, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213.
authors.forename: Jill L
authors.initials: JL
authors.lastname: King
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Bandos
authors.affiliation: Department of Radiology, Breast Imaging, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Jules H
authors.initials: JH
authors.lastname: Sumkin
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011857:Radiographic Image Interpretation, Computer-Assisted; D011871:Radiology / Q000331:legislation & jurisprudence*
keywords: breast cancer; breast density; mammography; reporting; screening