Nayak Lina, Miyake Kanae K, Leung Jessica W T, Price Elissa R, Liu Yueyi I, Joe Bonnie N, Sickles Edward A, Thomas William R, Lipson Jafi A, Daniel Bruce L, Hargreaves Jonathan, Brenner R James, Bassett Lawrence W, Ojeda-Fournier Haydee, Lindfors Karen K, Feig Stephen A, Ikeda Debra M
Stanford University, Stanford, California.
California Pacific Medical Center, San Francisco, California.
Breast J. 2016 Sep;22(5):493-500. doi: 10.1111/tbj.12624. Epub 2016 Jun 14.
Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management.
截至2014年10月，美国已有19个州通过了乳腺密度告知法，该法律要求告知患者其乳腺密度情况。本研究旨在评估此项立法对放射学实践的影响，包括乳腺癌风险评估及补充筛查研究的开展情况。2013年8月至2014年3月期间，通过电子邮件向乳腺影像学会的放射科医生发送了一份包含20个问题的匿名网络调查问卷。采用Fisher精确检验进行统计分析。来自美国34个州110家机构及1个加拿大机构的约121名放射科医生进行了回复。约50%（55/110）的机构有乳腺密度相关立法，36%的机构（39/109）开展了乳腺癌风险评估（1家机构未回复）。在有告知法的州，40%（6/15）的机构将风险评估作为因应密度立法而开展的一项新任务。然而，有法律的州的机构与没有法律的州的机构在进行风险评估方面并无显著差异（p < 0.831）。在预期会有乳腺密度立法的情况下，有法律的州中分别有33%（16/48）、6%（3/48）和6%（3/48）的机构实施了手持式全乳超声（WBUS）、自动WBUS和断层合成技术。有法律的州中提供手持式WBUS的机构比例显著高于没有法律的州（p < 0.001）。因应乳腺密度立法，超过33%的机构提供WBUS和断层合成技术的补充筛查，许多机构正在进行正式的风险评估以确定患者的管理方案。
