BEGINNINGS – Research shows that women with dense breast tissue are at a higher risk for breast cancer. But in Montana, they may not know this risk because their health care providers are not required to tell them.
Montana continues to be one of the few states that does not require health care providers, doctors and hospitals to notify women of the risk of breast density-related cancer.
Currently, there is no active push by state lawmakers to change the law, and only a handful of Montana hospitals have adopted voluntary guidelines to give to breast cancer patients. And efforts have stalled to similar extent at the federal level.
Risks of dense breast tissue
The Susan G. Komen Foundation of Idaho and Montana tracks breast density reporting and supports federal laws requiring mammography centers to report breast density information to health care providers and patients, said Emily Richards, director of the mission initiative group.
Richards says there are some alarming statistics linking breast density to cancer.
“High-density breast women are four to five times more likely to get breast cancer than women with low-density breast cancer,”; says Richards.
Dense breasts are also more common in young women and thin women. Also, 50 to 60 percent of women aged 40 to 44 have dense breasts.
But perhaps the most alarming statistic: mammograms alone may not be effective in detecting tumors in women with dense breasts, according to Richards.
In Montana, doctors do not need to inform women about dense breast tissue – a key risk for breast cancer
A street of a Missoula woman with dense breasts and cancer
And that’s exactly what happened to Missoula resident and breast cancer survivor Michelle Barthelmess.
“I’ve probably had that cancer for a year,” she said.
The cancer lingers in her body even after her mammogram came back negative.
“Every year you get into mammography, expect it to come back and it will be negative,” she said.
And in September 2016, that’s what happened. But in December, just two months later, she found a lump.
“I would describe it as feeling like the tip of your pipe. This is kind of what it felt like a little kind of hard,” she said.
The tumor never appeared.
Some mammography reports for women in Montana cite breast density, as proposed by FDA standards, in the form of a classification determined by a letter: A, B, C, or D.
But patients usually receive a notice in the mail saying their mammogram is “normal” or “negative” for cancer. Or not.
In Montana, no further explanation is required, as 38 other states across the country have already formed some sort of system of density reporting requirements.
Some states even provide women with insurance coverage, the next steps.
“So unless people are reading their medical records, I do not know how they will be informed,” Barthelmess said.
At the time, Barthelmess ended up going to Washington state for a second thought.
“I think to make any kind of medical decision, I like to have as much information as possible,” she said.
In the state of Washington, every patient with extremely dense breasts receives a written notice in a letter.
Barthelmess says the discovery in her letter was a wording that encouraged the patient to talk to their healthcare provider about risk factors associated with dense breast tissue.
Do hospitals in Montana voluntarily report breast density?
Even when a woman is armed with information about the density of her breast, the big question is, what does she do with it?
“You have to talk to your clinician and you have to ask for an extra check-up. But we did not know what the appendix examination had to be done at the time, “said Dr. Michael Stewart, a diagnostic radiologist working at two Missoula hospitals.
Stewart says cancer is only being lost by mammograms.
“As radiologists, we understand that this is really important and we do not like it when we lose cancer. “When we see a mammogram, something is hidden,” he said.
That’s why in November 2019, Providence Health in Missoula bought an Automated Breast Ultrasound, which is an additional 3-D examination that has the potential to find 35 percent more cancers that would not be found with mammography alone.
Furthermore, the organization changed the way breast density is reported to patients with information that includes informing the patient about additional screening.
“And we’re finding some cancers that are hidden,” he said.
While the tool is great for women living in and around the Missoula area, the option is limited to women living in rural Montana. And it’s just an option for women with qualifying insurance.
It’s another reason why the Komen Foundation advocates for more studies and resources available to women battling breast cancer.
“If a doctor and a patient agree to do additional breast images, such as ultrasound or MRI, insurance companies have to cover it, which is not always the case now,” Richards said.
In the Billings area, there is another option for women seeking peace of mind. It is an abbreviated MRI, available at Big Sky Diagnostic Imaging.
The service will cost a patient an out-of-pocket expense of $ 500.
“Say you went to your doctor and they do not see that cause for additional examination like a full MRI or potentially breast ultrasound, but you still have that concern,” Matt Keane told Big Sky Diagnostic Imaging.
“It’s really nice here to know you can say, I know, even without a doctor’s order I want to go ahead and verify that,” he said. “I want to find out more. “I want to take control into my own hands.”
Keane says Big Sky Diangostic is the only location in the state with this technology. When insurance has shut down women, MRI could be another life-saving opportunity, he said.
MTN Investigates checked with all the major hospitals in Montana to see who had an independent policy on reporting breast density to a patient other than Providence Health.
Only a handful of Montana hospitals responded to our request for comment.
At St Peter’s Health in Helena a spokesman issued the following statement:
“St. Peter of Health does not currently assign a value to individual breast density in mammography results documentation. We are currently evaluating how we can begin to provide this information so that more comprehensive results information is available to patients. We have in common that breast density may affect screening results, and we strongly recommend that patients discuss breast density and mammography results with their primary care provider, so that patients can obtain relevant information. health care with the right context and follow the recommendations. “
Those with the Billings Clinic said the hospital plans to formulate a policy in the spring of 2020.
A St. Vincent spokesman went through this statement:
“St. Vincent has been informing patients about breast tissue density in their results papers for about 6-7 years. We also recommend women who have very dense breasts talk to their referring doctor to have an MRI Screening “As well as Screening Mammograms. This recommendation is also expressed in the patient’s output letters. We also have information in our waiting areas regarding tissue density.”
Those with Advanced Images at the Community Medical Center passed a letter to women with thick breasts that reads in part:
“Your mammogram shows that you have dense breast tissue, which is VERY ECONOMIC and NOT abnormal, however it can make it harder to find cancer on mammography. To complete the screening procedure and detect all breast cancers. as clearly as possible, ABUS is recommended. “
How, then, can women choose the ones that are best for them?
Years after her diagnosis, Barthelmess gets breast cancer on trial. She spends her time in the summer as a dragon boat racing teammate with other survivors because the group allows her a support system.
“So you just have to live your best day,” she said. “Sometimes it’s the best feeling to help other people.
However, moving forward, she questions whether mammography will be enough.
“And that’s right, they do not know,” she said. “There are so many answers to my questions we do not know. And if I am in my fear-based anxiety state, then that makes me want to do everything. But when you get back to reality, it is, you know I can not live your life out of fear. “
The Mammography Reporting Act supported by the Comen Foundation was introduced in Congress in 2017 and is currently on hold.
Some states have decided to wait for federal legislation to be kept pending.
Jodi Weak with the Comena Foundation of Montana and Idaho says a dense breast bill has never been thrown before the Montana Legislature.
Meanwhile, Jim McKinney with the Food and Drug Administration told MTN Investigates that the FDA is working to finalize changes to the Mammography Quality Standards Act Amendments that include new requirements for breast density notification.
The proposed rule was published in March 2019 with a request for comments from the public.
The FDA is currently reviewing and reviewing comments on the completion of the rule.