Sizing Things Up

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Marianne Matthews, Editor, Imaging Economics

Guest post by Marianne Matthews, editor of Imaging Economics.

I had to chuckle recently when Jockey rolled out its new bra sizing system. Everyone from fashionistas to morning talk show hosts seemed obsessed with the news. It even garnered coverage (pardon the pun) on the front page of The New York Times. While some called the new bra sizing system important, others deemed it unnecessary and even downright confusing.

When it comes to their breasts, American women have a lot more important things to think about. And some of it—like understanding the real implications of breast density—can be as confusing as going from a 34B to a 7-36.

Although 10 states have now enacted breast density notification laws, the issue remains controversial. Proponents say it’s a no-brainer. They point to studies that show that increased breast density correlates with increased breast cancer risk. Experts say those with extremely dense breast tissue have twice the risk of breast cancer compared to those with average breast density. Moreover, dense breast tissue makes it hard to spot cancer on a mammogram.

So why not just enact legislation that mandates informing women of their density?

Well, there are a lot of reasons not to. Some of those opposed say the science is not perfect, density studies are misleading, and density alone is not necessarily a major cancer risk. Others fear the notification legislation will lead to too many tests and unnecessary biopsies. Still others object on principle to the government legislating medical care.

To be honest, I’ve had trouble sizing up the issue myself. Originally, I was all for notification legislation. Then, when I had a mammogram a few months ago, I talked to my radiologist. Turns out, she’s adamantly opposed to the density notification because she believes it will lead to “panic” among women. She’s not the only expert who feels density notification will only confuse women further, perhaps make them think they have cancer, or mistrust mammography altogether. She’s got a point. (There is a great deal of confusion among the highly educated women I know about breast density.)

So, I’ve gone round and round on the issue and come full circle. On balance, I think it’s a good thing. At this point, I see at least three simple reasons to support density notification laws.

First, in today’s society, patients are expected to be their own advocates—and doctors have pretty much made that the case. Doctors spend very little time in office visits actually communicating with patients. We’re expected to arrive prepared with our list of complaints and questions—and cover them all in less than 10 minutes. We’re expected to know our numbers. In some cases, we’re even forced to follow up on test results because all too often the physician’s office doesn’t bother to call with results. So, since we’re expected to be sophisticated patients—which takes some of the burden off of doctors—we need to be informed about our own bodies. That’s as good a reason as any to let women know if they have dense breasts.

Second, there is no turning back. Advocacy organizations are succeeding on Capitol Hill. In addition to the 10 states that already have density notification laws on the books, several more state legislatures have introduced legislation in 2013. What’s more, Federal legislation is under way. My point: You can’t put the genie back in the bottle.

Finally, as a radiologist, if you come out against density notification, you’re probably shooting yourself in the foot. Though I remain loyal to my breast imager, my guess is most women would not find her views all that favorable. In short, it’s politically incorrect for a women’s imaging provider to oppose the density movement.

So, you might as well use the density issue as an opportunity to educate your patients. Talk to her; get closer to her; show her radiology’s value. You can either be viewed as a foe or join the fight. That’s about the size of it.