Abstract P6-10-11: State based dense breast legislation and its effect on patient awareness

Recent efforts by advocacy groups to enact state government mandated legislation requiring that patients with dense breast tissue be informed of their breast density has been met with mixed responses by the medical community and cancer advocacy groups. Breast density has been well characterized as a risk factor for breast cancer, and is known to make mammogram interpretation more difficult. There are no formal recommendations for additional screening and management of patients who have dense breasts. There is no standard measurement in place for what defines dense breasts on mammography. Many women's health practitioners seeing radiology reports that comment on breast density are not adequately prepared to counsel patients in terms of best practice, as guidelines do not exist. Despite uncertainty of how knowledge of breast density impacts ongoing imaging or whether it impacts cancer early detection, 21 states have now enacted laws mandating breast density reporting It is unclear whether in states with mandatory reporting more patients are actually being informed about their breast density. "Are You Dense", the advocacy group driving this legislation, states that 40% of women have dense breast tissue and that 95% of these women are unaware of their breast density. The aim of this patient survey study was to determine whether state legislation for mandatory breast density reporting has altered the number of women informed about their breast density compared to states without mandatory reporting.

A 19 question survey was introduced using the social media site Facebook targeting women who are health conscious. Patients were asked to answer questions about their age, personal and family history of cancer, personal and family history of genetic testing, health behaviors including tobacco and alcohol intake and exercise habits and BMI, and personal history of breast screening results and whether they had been told they had dense breasts by a health care provider. Results were recorded and data analyzed using chi square and student t test.

17,936 women visited the survey site, and 15,392 women completed the survey. Of these, 3,536 women reported to be over 40 and eligible for mammography screening. 1,997 (56%) reported that they had been informed by a health provider that they had "dense breast tissue". Among patients residing in the 21 states with mandatory reporting, 59% (1231 out of 2098 responding) reported being told they had dense breasts vs 53% (766 out of 1438) of patients residing in states without mandatory reporting.

While groups advocating for mandatory reporting of breast density want to ensure that women with dense breast tissue are informed of their risk, and have access to an early breast cancer diagnosis, it is yet unclear whether this legislation impacts early cancer diagnosis or whether patients are actually being informed with increased frequency based on the legislation. Our study did not show a significant difference in the number of patients being informed of increased breast density in states with mandatory reporting. Additional studies are required to determine whether this legislation has any impact on patient awareness, uptake of additional screening, and earlier detection of breast cancer.

Citation Format: Lindner D, Vasic J. State based dense breast legislation and its effect on patient awareness. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-11.

Evidence of degraded BMD and geometry at the proximal femora in male patients with alcoholic liver cirrhosis

We examined the association of alcoholic cirrhosis in 33 patients with areal bone mineral density (BMD) and the assessed bone geometric strength of their proximal femora. Lower areal BMD, cross-sectional area and section modulus, thinner cortex, and higher buckling ratio suggest that the alcoholic liver cirrhosis is associated with lower measures of bone strength.

INTRODUCTION

Hepatic bone disease is an important complication of chronic liver disease and is associated with significant morbidity through fractures resulting in pain, deformity, and immobility. In this study, we examined the association of alcoholic cirrhosis and liver insufficiency stage with areal bone mineral density (aBMD) and additionally employed hip structure analysis (HSA) as an advanced method to assess bone geometric strength of the proximal femur in men with alcoholic liver cirrhosis.

METHODS

The study included 33 male patients with alcoholic liver cirrhosis and a control group of 36 healthy patients. Laboratory testing included the following biochemical markers of bone turnover: serum levels of osteocalcin and C-telopeptide of type 1 collagen. Areal BMD was measured by dual x-ray absorptiometry on the proximal femora. Structural parameters were then derived from these scans using hip structure analysis software.

RESULTS

After adjusting for age, body height, and weight, we found lower cross-sectional area (p = 0.005) and section modulus (p = 0.005), thinner cortex (p = 0.012), and higher buckling ratio (p = 0.043) in the neck region among patients with cirrhosis. The findings suggest that alcoholic liver cirrhosis is associated with lower measures of bone strength. These findings were consistent with decreased osteocalcin values and increased C-telopeptide of type 1 collagen in patients with cirrhosis, indicating reduction in bone formation and increased bone resorption.

CONCLUSION

Our results emphasize that HSA-derived structural indices of proximal femoral structure may be an important index of greater fragility in patients with alcoholic cirrhosis.

Retrobulbar chondrosarcoma in a dog

This paper presents a review of a dog, with a retrobulbar chondrosarcoma, which was admitted for surgery for visible changes in his eye during inspection. Orbital neoplasia in dogs may be primary and secondary. Sixty percent of orbital neoplasia in dogs are primary, ninety percent of which are malignant. Retrobulbar neoplasms are rare and in their early stage represent a diagnostic challenge. Chondrosarcoma of the skull is a slow-progressing malignant disease which occurs locally, aggressive with invasion into the surrounding tissues. Dogs with chondrosarcoma of the skull have life expectancy between 210 and 580 days - in our case it was 180 days - after the first alterations on the eye of the dog occurred.