Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY.
Am J Public Health. 2019 May;109(5):762-767. doi: 10.2105/AJPH.2019.304967. Epub 2019 Mar 21.
To evaluate the association of state dense breast notification (DBN) laws with use of supplemental tests and cancer diagnosis after screening mammography.
We examined screening mammograms (n = 1 441 544) performed in 2014 and 2015 among privately insured women aged 40 to 59 years living in 9 US states that enacted DBN laws in 2014 to 2015 and 25 US states with no DBN law in effect. DBN status at screening mammography was categorized as no DBN, generic DBN, and DBN that mandates notification of possible benefits of supplemental screening (DBN+SS). We used logistic regression to examine the change in rate of supplemental ultrasound, magnetic resonance imaging, breast biopsy, and breast cancer detection.
DBN+SS laws were associated with 10.5 more ultrasounds per 1000 mammograms (95% CI = 3.0, 17.6 per 1000; P = .006) and 0.37 more breast cancers detected per 1000 mammograms (95% CI = 0.05, 0.69 per 1000; P = .02) compared with no DBN law. No significant differences were found for generic DBN laws in either ultrasound or cancer detection.
DBN legislation is associated with increased use of ultrasound and cancer detection after implementation only when notification of the possible benefits of supplemental screening is required.
评估州级密集型乳房通知（DBN）法规与乳房 X 光筛查后补充检查和癌症诊断的相关性。
我们检查了 2014 年至 2015 年间在 9 个实施 DBN 法规的美国州和 25 个没有 DBN 法规的美国州的私人保险女性（年龄 40 至 59 岁）进行的筛查性乳房 X 光检查（n=1441544）。筛查性乳房 X 光检查时的 DBN 状态分为无 DBN、通用 DBN 和要求通知补充筛查可能获益的 DBN（DBN+SS）。我们使用逻辑回归来检查补充超声、磁共振成像、乳房活检和乳腺癌检出率的变化。
与没有 DBN 法规相比，DBN+SS 法规与每 1000 张乳房 X 光片增加 10.5 次超声检查（95%CI=3.0，17.6 次/1000；P=0.006）和每 1000 张乳房 X 光片增加 0.37 例乳腺癌检出（95%CI=0.05，0.69 次/1000；P=0.02）相关。通用 DBN 法规在超声检查或癌症检出方面均无显著差异。
只有在要求通知补充筛查可能获益时，DBN 立法才与实施后超声检查和癌症检出率的增加相关。
