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Better breast cancer detection saves lives

A year from now, more than a decade after groundbreaking action here in California, a new federal law will take effect improving breast cancer screening in women with dense breast tissue.

In 2012 as a State Senator, I authored SB1538, which required that, following a mammogram, women be told they have dense breast tissue and that there were a range of alternative screening options they should discuss with their doctor.

Why is this important? Because dense breast tissue makes abnormalities like cancer more difficult to see on a mammogram and increases a woman’s risk of cancer.

In March, the U.S. Food and Drug Administration issued a ruling that establishes uniform baseline standards nationwide to promote access to quality mammography services, as well as newly required statements that must be provided to patients with dense breasts — essentially what we did in California 10 years ago.

The new FDA requirements take effect Sept. 10, 2024 — appropriately, the same month in which World Dense Breast Day occurs — giving states time to come into compliance.

By requiring information on dense breast tissue, the federal law will ensure that women — in all 50 states — are better informed about their bodies and will help them make better decisions about the medical screening or care they might need. Early detection of cancer is the key to saving lives. It also reduces health care costs and suffering, because cancer caught early can be treated less expensively and with less hardship to the patient.

I authored the California bill after a constituent, Amy Colton, suggested the idea in my annual “There Oughta Be a Law” contest. Colton, a registered nurse, was shocked when she was told she had breast cancer after years of normal mammograms. She learned that she had dense breast tissue only after her cancer treatment.

About 50 percent of women have dense breast tissue, and the risk of breast cancer for women with extremely dense tissue is about five times greater than for those with low breast density. Mammographic sensitivity for breast cancer declines significantly with increasing breast density — both the cancer and the dense tissue appear white.

A decade ago, some people thought my legislation was an implicit criticism of mammography; it was not. But we know that for a particular group of women — and large group at that — mammography has its limitations.

Fortunately, technology has come a long way. Digital breast tomosynthesis is quickly gaining in popularity. For some women, depending on their breast density and cancer risk, MRI or ultrasound screening may be recommended.

I am heartened that health care providers nationwide will soon be required to share this vital information with patients, yet struck that it is literally a decade after we made this case in California. I hope that those concerned about women’s health continue to do all they can to make women aware of this issue, to encourage them to ask the right questions about their cancer risk and to consider alternative screening possibilities, as well as other early detection and prevention measures.

This column is dedicated to the late Nancy Cappello, the founder of Are You Dense? For more information about dense breast tissue, visit: 

Joe Simitian
Santa Clara County Board of Supervisors

This article was originally published in Los Gatos Living and Saratoga Spotlight in September 2023.