Breast-density bill to become law in Virginia

RICHMOND — Cathryn Tatusko donned the hospital gown, got squeezed by the mammogram machine, went home and waited for the all-clear letter. Every year. Without fail. For 14 years straight.

Her last mammogram showed no sign of trouble. It took place the same day she received a diagnosis of late-stage breast cancer.

“I just can’t possibly have breast cancer because I just had a clean mammogram,” the Annandale nurse thought at the time. “That’s not how it works.”

Since that day 2 ¹ / ₂ years ago, Tatusko has discovered that really can be how it works for women who, like her, have dense breast tissue.

Mammograms miss about 40 percent of cancers in women with dense breast tissue, medical experts say. What’s more, women with dense tissue are thought to be at significantly greater risk for breast cancer.

Other imaging techniques, such as MRIs and ultrasounds, can detect some tumors in dense tissue better than mammograms. But those tests have their own shortcomings. They are also very expensive and generally not covered by insurance, so doctors don’t use them for routine screenings.

Tatusko, now 56 and considered cancer-free after two years of aggressive treatment, is on a mission to change that. And partly because of her efforts, Virginia is set to become the third state, after Connecticut and Texas, to require radiologists to notify patients if they have dense breast tissue.

The Virginia House and Senate unanimously passed bills this General Assembly session requiring that radiologists put information about breast density in post-mammogram letters to patients.

“This is a common-sense measure to ensure women’s health,” said Taylor Thornley, a spokeswoman for Gov. Robert F. McDonnell (R), who intends to sign the legislation.

While enjoying overwhelming support now, the bills were met with behind-the-scenes resistance from Virginia radiologists. Concerned that women would be unduly alarmed, turned off from life-saving mammograms, and left footing the bill for unnecessary and expensive tests, they quietly lobbied against the legislation. They succeeded in changing the proposed language so that it would alert women to density but not suggest that they seek other tests.

Breasts are a mix of fatty and dense, glandular tissue. On a mammogram, the fatty tissue looks gray. The dense tissue looks white. So do cancers, which is why it is hard to spot tumors amid dense tissue and why additional testing can be useful for patients with dense breasts.

But radiologists are concerned that sending information about breast density to patients could cause problems, said Gilda Cardenosa, director of breast imaging at Virginia Commonwealth University Medical Center.

Cardenosa said she fears that even the toned-down legislation will cause women to lose faith in mammograms — “one of the best tests in medicine” — at a time when they’re already under fire. A federal health panel upended conventional breast-health wisdom in late 2009 by suggesting that women could wait until age 50, instead of 40, before getting mammograms, and then get them every other year instead of annually.