Breast Density Notification Laws in the USA Found to Considerably Raise Costs Yet Save Few Lives

Laws requiring supplemental ultrasound screening for women with dense breasts would significantly increase costs and save comparatively few lives, according to new research.

The study was conducted by investigators from a number of leading medical institutions worldwide, including the University of Vermont (Burlington, Vermont, USA); Harvard Medical School (Boston, MA, USA); Albert Einstein School of Medicine (Bronx, NY, USA), and Erasmus Medical Center (Rotterdam, the Netherlands). They published their findings online December 9, 2014, in the journal Annals of Internal Medicine.

More than 50% of women between the ages of 40 and 74 have dense breast tissue, which puts them at increased risk for breast cancer and affects how well a mammogram can identify abnormalities. As such, at least 19 US states have enacted breast density notification laws so that women can make informed decisions about supplemental screening, such as ultrasound.

With similar legislation being considered at a national level, researchers sought to determine the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Three validated simulation models predicted that supplemental ultrasound screening after a negative mammogram for women with dense breasts would result in limited health gains and substantially increased expenses.

According to model estimates, supplemental screening for women with dense breasts and a negative mammogram would save 0.36 additional breast cancer deaths, gain 1.7 quality adjusted life years (QALYs), and result in 354 false-positive ultrasound biopsy recommendations per 1,000 women with dense breasts compared to biennial screening by mammography alone. The cost-effectiveness ratio was USD 325,000 per QALY gained, but costs could be improved by restricting supplemental ultrasound screening to women with extremely dense breasts.

Related Links:
University of Vermont 
Harvard Medical School 
Albert Einstein School of Medicine