The American Congress of Obstetricians and Gynecologists (ACOG) - District IX, The California Radiological Society (CRS), the California Medical Association (CMA), the Medical Oncology Association of Southern California and the Association of Northern California Oncologists have come together to show opposition to Senate Bill 173 (Simitian).

While the intent of the bill is to give women more power and control over their health by providing information to women found to have highly dense breasts, the legislation is vague and would impose undue cost burdens on the patient. Additionally, California law already requires health insurers and plans to cover medically appropriate breasts cancer screening tests.

"In fact, half of women have been found to have highly dense breasts and a mammogram may not be able to pick up small abnormalities in any breast- dense or not," Dr. Bodai, Director, Breast Surgical Services at Kaiser Permanente-CSA said. "This legislation outlines a course of action that is vague and in many cases, not necessary. Many of my colleagues and other major physician organizations have examined the intent, the science and the cost of this bill and find it to be lacking," he added.

For the state to mandate information to patients, the information must be clear. While significant data has been gathered, there is not yet clarity on what "dense breasts" mean and what should be done clinically. To suggest women may need additional screening without this medical clarity is not suitable for inclusion in a state mandate.

"As part of the mammography report, the radiologist already reports density information to the referring physician," Dr. James. G. Hinsdale, M.D., President of the California Medical Association (CMA) said. "The patient's physician should consider dense breasts as a factor along with other risk factors, such as age, history of breast cancer in family and prior mammograms."

Data is voluntarily being collected through the national American College of Radiology Breast Imaging Reporting and Data System (BI-RAD) system to enable data analysis so that it will become clearer about what actions should be taken in the case of high breast density. Once data is sufficient, professional medical guidelines will change to reflect this new information.

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. Affluent women will be able to pay out-of-pocket if they choose, but lower income women might not have the option to be able to afford $300 for an ultrasound and $1700 for an MRI.

Source:
California Medical Association