Wednesday, September 21, 2011

The Golden State's Dense Breast Tissue Bill: An Argument In Favor

Today I'll continue the discussion on California's dense breast tissue bill, SB 791, sponsored by Joe Simitian of Latest Medical's hometown of Palo Alto. The bill is similar to bills recently passed in Connecticut and Texas. Basically, it would require physicians to notify patients with highly dense breasts about their breast density and the possibility that they may require additional imaging services like ultrasound or MRI. The California Medical Association (CMA) and many physicians oppose the bill. Patients and patient advocates tend to support it. 
As the founder of a company focused on empowering cancer patients with information, I support the bill. To me, nothing justifies withholding potentially life-saving information from patients.
The simple, central issue is that today most women are not being informed about a serious health risk: dense breast tissue. According to a recent poll, 95 percent of women ages 40+ don’t know their breast density and close to 90 percent don’t know it increases the risk of developing breast cancer.  Yet the medical community has known about this issue for over a decade.
What are the arguments against the bill? I’ll use the CMA as a proxy for the opposition. In their press release, the CMA states that there isn't yet clarity on what "dense breasts" means, nor on what should be done clinically with the information. But "clarity" is a vague term. In fact, there's well over a decade of research about the risks associated with dense breast tissue and on the value of supplemental screening. It’s common sense that imaging the breast using different, proven methods will increase the likelihood of finding an abnormality. But we don't have to rely on common sense. Recent studies published in high quality medical journals come to the same conclusion.
In fact, as an argument against the bill, the CMA's press release says that breast density is already reported to physicians in mammography reports. Isn't this an admission that there is a workable way to measure breast density and that the information has clinical relevance?
One can concede that the measurement of breast density is an ongoing area of research. And one can concede that the value of different supplemental screening methods is still being quantified. The CMA's policy statement says that, "the science is still out on this matter." Yes, science is never finished. It's always still out on every matter.
Another CMA argument cites the bill's impact on patients (they'll be scared) and physicians (they'll face practical and legal problems). Possibly.  But these are secondary issues--consequences of communicating the facts. The truth can't be sacrificed for the sake of convenience. The priority must be patients' health, not shielding them from worry or protecting physicians.
Finally, one can argue that what's needed is better cost-benefit data regarding supplemental screening of women with dense breast tissue. But the bill doesn't involve changes to reimbursement. Maybe it should. But right now it's only about communicating information. Once they're informed, women can do their own cost-benefit analysis with their doctor. They can weigh in their other risk factors, their anxiety level about developing breast cancer, their level of concern about a possible unnecessary biopsy, and their ability to pay for supplemental screening if it isn't covered. This is a decision that women need to have the opportunity to make. The bill ensures that they will.
Without the notice that the bill requires, we know that many women with very dense breasts who aren't aware of this issue will be at risk while we wait years for the results of more definitive randomized controlled trials. SB 971 is important for the simple reason that people have the right to make decisions about their health based on the best available information.
Tomorrow I'll go into what I view as another reason why it's important to empower patients with this kind of information.

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