Breast cancer detection bill passes Legislature

Women with dense tissue to receive notice of increased false-negative mammogram readings

A new breast cancer detection bill authored by State Sen. Joe Simitian, D-Palo Alto, passed the California Legislature Monday (Sept. 12), requiring medical professionals to inform their patients that dense breast tissue could mask cancer when they have a mammogram.

Dense breast tissue appears white on a mammogram, and cancer also appears white, so it can be very difficult to see the cancer, Simitian said.

Senate Bill 791 requires that following a mammogram, patients with dense breast tissue be informed that they have dense breast tissue; that dense breast tissue can obscure abnormalities such as cancer on a mammogram; and that the patient may wish to discuss the potential value of additional screenings with their doctors.

A January 2011 study by the Mayo Clinic found that in women with dense breast tissue 75 percent of cancer is missed by mammography.

The National Cancer Institute estimates that one in eight women will develop breast cancer. More than half of all women have dense breast tissue, and risk among that group is five times greater than for women without dense tissue.

Senate Bill 791 requires that, for patients with dense breast tissue, two additional sentences be included in the federally required letter that a radiologist must send a patient after performing a mammogram.

"Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this notice."

The bill will now go to Gov. Jerry Brown. Simitian represents the 11th state Senate district, which will include Mountain View in next year's election.

Simitian said he introduced the bill because he thinks the "two-sentence notice can save thousands of lives. The bil1 will also save money, because treating cancer in its early stages is far less expensive than battling advanced cancer," he said.

"When it comes to your health, ignorance is not bliss," Simitian said. "This bill is about giving patients the information they need to make informed decisions about their own bodies and their own health."

Soquel resident Amy Colton, a registered nurse and a cancer survivor, suggested the bill in Simitian's annual "There Oughta Be A Law" contest. Colton was never informed of her breast density during years of routine mammograms. She only discovered that she had dense breast tissue after completion of her treatment for breast cancer, which her mammograms had failed to detect over several years, according to Simitian's office.


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Posted by Concerned
a resident of Castro City
on Sep 13, 2011 at 2:47 pm

OK, I admit that this is a step in the right direction.
But, it is a tiny, pidling shuffling step!
Insurance only covers mamograms, despite the fact that (according to this article) are only useful for about half the women. Despite the fact that medical science is continuing to develop MUCH BETTER screening methods, these are rarely covered by insurance. So, while this bill is a good thing, I'm afraid that in my case it is just going to add to the fear & uncertainty in my life by not knowing if the mamogram is accurate or not.

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Posted by Medical QA Guy
a resident of Rex Manor
on Sep 13, 2011 at 4:36 pm

The headline struck me as odd; why not "mammogram disclosure bill"? The relevant numbers in the story tell us that cancer detection via mammogram is unlikely for over half of women, those with dense breast tissue (DBT). Their readings should be labelled as "inconclusive" given that the false-negative rate is an overwhelming 75%. Clearly all the statistics are different for DBT women. A little algebra teases them apart from the fortunate few (or less than half) non-DBT women. Approximating the incidence of DBT as 1/2, the 1 in 8 overall BC rate would break down to only 1 in 24 non-DBT, along with 5 in 24 (over 1 in 5) DBT women, having cancer at some time. I'd like to apply Bayes' formula to the subgroup of women with dense breast tissue (despite the fact they probably shouldn't trust their mammograms) to figure out their actual probability of cancer given a "positive" mammography verdict: With DBT, prob of a positive mammogram given (previously undetected) cancer is (only) M|C = 1/4 and Bayes tells us C|M = (M|C) C / M = (1/4) * (5/24) / M where M is prob of a positive mammogram, which is unfortunately not given (for either subgroup) but is no more than 1, so the probability of cancer given a positive, dense-tissue mammogram is at least 5/96 or 1 in 19. We already knew their "prior" probability was 5 in 24. So if anything, a mammogram, for most women (those with DBT), would create a false sense of assurance-- hence the need for a clear, specific disclosure! What's most clearly needed is a test for early-stage breast cancer that produces meaningful results for the vast majority of women. Maybe a biochemical assay.

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Posted by Medical QA Guy
a resident of Rex Manor
on Sep 13, 2011 at 5:32 pm

...and/or ultrasound...? By the way, the cancer incidence rates (5/24 with DBT and 1/24 without) I figured were lifetime totals, so my result for C|M (probability of cancer given a positive mammogram, ever) for those with DBT would also be cumulative. Depending on how the clinician calibrates her "positive" rate M (which should be higher for DBT), then C|M, the probability of a patient with DBT ever having breast cancer, given that she ever has a positive mammogram, could be between 25% (the "ideal" case, for M = 5/24)and 42% (the "naive" case, for M normalized to equal the total cancer rate of 1/8). My point is, it's really hard for a patient with DBT to figure her actual odds.

At least, it's hard for me. Which could help explain my unemployment.

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Posted by Kimwhit
a resident of another community
on Sep 18, 2011 at 10:51 am

I couldnt say it better than Timothy Boyer though I have been outspoken and aggressively pursing the passage of this legislation as a women and an advocate for patient awareness and empowerment:

The controversy of Senate Bill 179 brings to light two points: The first is that a mammogram as a sole diagnostic tool is insufficient toward protecting 40% of the women in the United States. Science needs to come up with better and affordable diagnostic tools.

The second point is that it is evident that the medical field continues to foster a paternalistic attitude toward women’s rights and their need to know. Yes, information can cause anxiety, but is that necessarily a bad thing? Information can also relieve anxiety and lead to positive results. To withhold information from a patient and charge them for a test that may not be doing what the patient is led to believe is unconscionable. Perhaps that is the real hidden cancer.

his piece is well sighted if you want to read more:Web Link

Medical QA guy I would like to speak with you - I am at

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Posted by kimwhit
a resident of another community
on Sep 18, 2011 at 11:18 am

If you support Senate Bill 791 (was 173) you can contact Governor Brown's office - it WILL make a difference:
Phone the Governor’s office at (916)445-2841 and say:
“My name is _________ and I am a resident of __________, California. I’m calling to urge Governor Brown to sign SB 791, the breast density inform bill into law.”
Click on this link: Web Link
On the lower half of the page you will see “Email the Governor”. Under the “Please choose your subject” drop down menu, choose “Other”. Check the box if you want a reply
Click on the “Submit” button to go to the next screen. Where it says “Your position” click on “Pro”. In the Subject field type “SB 791”
Copy & paste the message below (or write your own message) in the “Write your email” box and sign your name at the bottom of the message.

You can use this sample message or create your own personal message:

Dear Governor Brown,

I am writing to urge your signature on Senator Joe Simitian’s SB 791 (the breast density inform bill). SB 791 will provide the 40% of all women who have dense breast tissue an increased opportunity for the early detection of breast cancer. This bill arrives at your desk not only with overwhelming support from California constituents, but with a nearly unanimous show of bi-partisan support from the California legislature, continuing the proud tradition of the people of the State of California in promoting the rights of women to be proactive partners in their own healthcare.

Recognizing your own equally long commitment to women’s health, and the need to make further inroads against the devastation that continues to be caused to families and communities by the 4,000 California women who will die of breast cancer in 2011 and the over 25,000 Californians that will be diagnosed with the disease in 2011, I urge you to sign SB 791 into law.

There is hardly a family or household which has not been touched in some way by this tragedy. The best chance for successful treatment and survival of this terrible disease is early detection. However, under the current practice, for women with dense breast tissue the diagnosis comes at a very late stage. Your signature will ensure that patients have a critical piece of information about their own health that will literally save lives.


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Posted by kimwhit
a resident of another community
on Sep 18, 2011 at 11:20 am

Timothy's article is well cited!!!! not well sighted.....sorry.....tired

Sorry, but further commenting on this topic has been closed.

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