Breast tissue density has become a much discussed element of a woman's breast cancer risk. Patients' lack of knowledge about breast density remains a concern, but radiologic technologists may be able to help, according to a talk on Monday at the National Consortium of Breast Centers (NCoBC) meeting in Las Vegas.
"Who has the most interaction with the patient? The technologist," said presenter Jerry Kolb, CEO of breast reporting software developer Ikonopedia. "There's an important role for the technologist in patient education regarding tissue density."
The movement toward breast density notification legislation began in Connecticut in 2009, which was the first state to pass a bill, Kolb said. Now 16 states have passed their own versions, and density notification requirements apply to more than 50% of U.S. women. A federal effort is also in the works.
But even if women are being told about their breast density, are they following through with additional imaging, which is usually ultrasound?
"Compliance equals convenience," Kolb said. "Women like the idea of the ultrasound -- but they're busy, and some are put off by the cost of additional appointments. It's imperative that all screening procedures occur on the same visit."
Breast centers need to establish a protocol that treats ultrasound as an add-on procedure if a woman is found to have dense tissue. Technologists are key to this kind of workflow, according to Kolb.
"Techs can talk to the patient about her particular density, and move her directly to ultrasound if appropriate," he said.
For such a model to work, breast care centers need to notify and educate referring physicians as well, Kolb said. Use written materials that describe how density affects mammography's sensitivity, emphasize the value of early detection, and include a conditional contingent order for additional imaging, he advised.
"A conditional contingent order outlines center protocol for the screening and diagnostic process, and allows the referring physician to order screening or diagnostics without needing to be specific," he said.
Kolb described an example of the process:
- The center adopts a protocol that specifies that all screening patients with dense breast tissue will be offered adjuvant screening ultrasound.
- The patient receives a reminder letter with an enclosed pamphlet describing breast density and the availability of additional ultrasound imaging.
- The patient arrives at the center and receives the same pamphlet again at registration, and she signs the advance beneficiary notice that makes patients aware of their financial responsibility for additional services.
- The patient receives a standard screening mammogram.
- Before the patient leaves the room, the technologist explains density again.
- If the patient has dense breasts, she is offered screening ultrasound.
The technologist's role should be directed by protocol, according to Kolb.
"Technologists can engage women in a discussion of density and its potential affect on mammography's sensitivity, discuss their breast tissue density if the information is available, and offer patients with dense tissue additional imaging," he concluded.
