MedicalResearch.com Interview with:
Michal Horný PhD
Emory University School of Medicine, Department of Radiology and Imaging Sciences
Emory University Rollins School of Public Health
Department of Health Policy and Management
Atlanta, GA 30322
MedicalResearch.com: What is the background for this study?
Response: Increased breast tissue density is a common finding at screening mammography. Approximately 30-50% of women have so-called “dense breasts” but many of them are not aware of it. The problem is that the increased tissue density can potentially mask early cancers. In other words, if there is cancer hiding in dense breast tissue, it could be difficult to spot it.
To improve the awareness of breast tissue density, a patient group called Are You Dense Advocacy, Inc., started lobbying state and federal policymakers to pass laws mandating health care providers to notify women about their breast density assessments. As a result, 31 states have already enacted some form of legislation regarding dense breast tissue.
MedicalResearch.com: What are the main findings?
Response: Our previous study documented an increased use of breast ultrasound in most states that enacted some form of dense breast legislation. We also found that the use of breast ultrasound in some states increased more than in others. In this most recent study, we investigated whether this differential effect could be explained by specific and unique characteristics of the approaches taken those various states.
We identified law characteristics that were associated with increased use of breast ultrasound, such as the explicit recommendation to get a breast ultrasound in the notification sent to patients, or a mandate for health insurance plans to cover the costs associated with supplemental ultrasound imaging. We also identified characteristics that moderated the effect.
MedicalResearch.com: What should readers take away from your report?
Response: Policymakers need to pay close attention to specific aspects of the laws they introduce in response to pressures from interest groups. On one hand, low-involvement approaches such as a passive provision of information may not have the impact desired by interested stakeholders. On the other hand, high-involvement approaches such as mandating certain behaviors of patients, providers, or payers may intensify the impact, but carry with them considerable costs (that is, the costs associated with downstream imaging, for which payers may be paying, at least in part, out of pocket).
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should investigate whether the enacted laws actually led to improved health outcomes such as decreased mortality due to breast cancer.
Disclosures: Our research team had no financial conflicts of interest, and we are fully independent of Are You Dense and any other such advocacy groups.
Michal Horný, Michael Shwartz, Richard Duszak, Cindy L. Christiansen, Alan B. Cohen, James F. Burgess. Characteristics of State Policies Impact Health Care Delivery. Medical Care, 2018; 1 DOI: 10.1097/MLR.0000000000000967
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