Dense breast tissue bill goes to the governor

Physicians would be required to inform women who have extreme breast density, a condition that masks potential cancerous tumors in mammograms, under a bill approved by both chambers on the final day of the legislative session Friday.

The legislation now goes to Gov. Jerry Brown’s desk.

The bill, SB 791, (previously SB 173) had been bottled up in the Appropriations committee after heavy lobbying by the California Medical Association and other medical provider groups. It didn’t look good. It appeared as if the power play of a Capitol heavyweight would prevail despite overwhelming support at every stage of the bill’s path through the Legislature.

But Sen. Joe Simitian, D-Palo Alto, made some changes that satisfied Assembly Speaker John Perez, D-Los Angeles, and it sailed through the Assembly, 57-6, and, later, in the Senate, 35-1, Friday, the latter vote after midnight.

“It’s two sentences that can save thousands of lives,” Simitian said.

The issue became a flashpoint for supporters, who learned of the story of Amy Colton in a story I wrote last week. Colton had taken mammograms for seven years, reassured each year that her results were fine, until she was told she had an advanced case of breast cancer. Colton later learned that she had extreme breast density, which is known to mask the readings of mammograms.

She also learned that her doctor and radiologist knew of her condition but never told her.

“It took my breath away,” Colton told me.

After the vote was taken at 12:30 a.m. Saturday, Colton wrote me in an email, “unbelievable!!!!!!!”

“I’m THRILLED that the California legislature has demonstrated their overwhelming support of breast density notification,” Colton wrote to me. “Armed with this information women will be able to make fully informed decisions regarding their breast health. Senator Joe Simitian is to be commended for his herculean, successful effort to move this bill forward!”

Simitian said his office received a flood of calls in support of the legislation and forwarded them to Perez’ office all week.

The California Medical Association remained opposed, and leaned on a physician in the Assembly, Linda Halderman, R-Fresno, to argue their case.

“In my practice, I couldn’t offer tests wtihout paying for them myself — MediCal didn’t pay for it,” Halderman, who added that she had to shut down her practice partly because of costs she had to cover to provide patients with ultra sound tests of women with dense breast tissue.

“This is not ready, this is not the place to practice medicine,” Halderman said.

Halderman said that the legislation would increase liabilities for doctors, which would lead to a rise in biopsies, hence more complications.

Assemblywoman Holly Mitchell, D-Los Angeles, said that it is “important that women be given information and the tools they need to partner with their physicians. To argue women can’t manage information about their own bodies, that they’ll overreact with too many procedures, is insulting.”

Steven Harmon

  • Truthclubber

    People over profits!

    Democracy over fascism!

    Truthclubber over Hellwad!

  • Elwood

    Enjoying your weekend trip?

  • Sara and Meg WHO ??!!!

    Huh ?

    WTF does #2 have to do with ANYTHING ??

    Pure off-topic, non-specific personalized B.S. which does nothing to add to the conversation EXCEPT to frustrate.

    Why does Elwood choose to make personalized anecdote the king post of a preponderance of his/her/its arguments ?

    Who benefits from this kind of nonesense ??

    Murdoch would be proud. . .

  • Elwood

    You’re hallucinating!

  • bbox231

    Who benefits from this kind of yellow nonesense ?????? Think carefully . . . . .

  • John W

    I think the banter betwee E and T is just part of some mating ritual that is not ours to comprehend.

  • I learned about breast density last October when I spoke at Maria Shriver’s Women’s Conference in Long Beach. 40-70% of us have dense breasts & likely DONT KNOW & have NEVER BEEN TOLD. I can’t imagine ANY circumstance or possible reason why my breast density would be withheld from me but would be disclosed to my physician. It is almost impossible for mammography (even digital) to detect a cancerous lesion in a very dense breast. I have read the CMA, CRS & ACOG positions, and listened to Amy Colton, Drs Roux,Dean & Stavros (who wrote THE book on Breast Ultrasound Education!) and Nancy Cappello, Founder of AreYouDense.org. I have urged you to consider what it might be like to learn that you, your mother,sister,spouse or friend is dense breasted & see if you can empathize with women who only learn that after their mastectomy, chemo & radiation.

    There is still one hurdle left before this bill becomes law and that is a signature from Governor Brown who has until October 9th to sign the bill. I will keep you all posted on what, if anything, you can do to help in that effort over the next several days and weeks. But for now know that you who have supported the courageous and inspiring Amy Colton and her bill have helped all of the women of the state of California in an immeasurable way.

  • John W

    I’m no expert on the issue, but I am puzzled as to what possible reason doctors would have for intentionally not disclosing the information. If it’s just an matter of awareness, it seems to me that the medical community has journals, associations, bulletins etc. through which they are routinely updated on things like this. I’m reluctant to have political bodies get into telling physicians how to conduct their practices or what they have to communicate to their patients, whether it’s about breast density or telling docs what they must tell or show a patient before performing an abortion.

  • Shelley

    It is so simple! Preventive medicine will save us all money and it will SAVE LIVES!! This bill is long overdue. I hope Gov Brown signs it soon.

  • Janet

    There is no down side to information. Knowing that you have dense breasts is a woman’s right to know. If she chooses to have an ultra sound, again, her right to decide.

  • John W

    Of course docs should disclose the information, but this legislation makes it seem as though they have some self-serving reason for not doing so. I would think just the opposite is the case. We don’t need the legislature getting into the business of creating “to do lists” for physicians. It’s like telling a gastro doc he should disclose to a patient that he found a polyp during the colonoscopy or telling a dermatologist to disclose that somebody has a carcinoma. Brown should veto this.

  • Amy C

    You’re right John W, notification of breast tissue density should NOT have to be legislated…this information should be forthcoming to the patient, but it’s not! Without this critical piece of information, women with dense breast tissue do not have the opportunity for EARLY detection of breast cancer. Cancer is most successfully treated and survival is more favorable when it is caught early . Far too many of us, myself included, have needlessly suffered late stage diagnoses because our breast density masked the cancer! Had we been informed of the decreased ability of mammography to detect cancer in dense breast tissue, and of the 4-6 times greater risk of developing cancer, we could have discussed supplementary screening methods with our physicians and most likely have received an early diagnosis. Governor Brown should sign this bill into law!

  • kelly k.

    As a breast cancer survivor and a mammographer, I am all for having this legislation passed. My cancer was not detected by mammography because my tissue is extremely dense. Fortunately, I had the resources and the knowledge to follow up on an area in my breast that just did not feel like all the other benign masses I had encountered in the past. Ultrasound found my lesion. If women are made aware of their breast density and the inherent risks that come with extremely dense tissue, they can be more proactive in their future healthcare.

  • Taylor Phillips

    Over 90% of women have no idea what type of breast tissue they have. Why? Because it has not been the standard of care to inform the woman. Over 40% of women in this country have dense tissue. Over 70% of all breast cancer is found in women with dense breast tissue. Dense tissue that shows up white on a mammogram. Cancer shows up white. It’s like looking for a snowball in a snowstorm. Mammography is not enough for women with dense tissue. Ultrasound and MRI can see what mammography can’t. This bill gives women breast density education so they can make a choice to get additional screening. I am a dense breasted cancer survivor whose cancer was mammographically occult. I want to spare other women from going through what I did. This bill gives women breast density knowledge and a choice. Please Gov. Brown, sign this into law is no one else but for the dense breasted women in your life. Remember, 40% of all women you know are dense breasted and according to published data, 1 in 300 are walking around with a mammographically occult cancer. Please sign this into law.

  • John W

    I truly emphathize with all the above comments. I have lost dear friends to breast cancer. I don’t think anybody who has posted here disagrees on what the standard of care (and disclosure) should be in light of current knowledge. Now that this issue has received so much attention, a physician would have to be a complete incompetent not to diagnose and disclose; not to mention a malpractice suit waiting to happen. And women should be aware of and insist on it. I just don’t think the state legislature is an appropriate venue for codifying standards of care, which are continually evolving in all areas of medicine. Take PSA testing, for example. A few years ago, somebody might have written a “common sense” law saying that every male over a certain age should receive an annual PSA test and that the results should be fully disclosed. That is no longer the standard of care, but the law would still be on the books long after the medical community had developed new thinking on the subject.

  • Amy C

    Unfortunately, John W, although breast density has received more attention lately, most physicians are still NOT notifying their patients if they have this condition. In fact, the results of this recent Harris Interactive Survey (http://www.senatorsimitian.com/images/uploads/Harris_Survey.pdf) show that only 9% of doctors are informing their patients and 95% of women don’t know their breast density. Also, this bill does NOT mandate any testing as your analogy to PSA testing suggests. This bill is a simple, 2 sentence notification which informs the patient that the results of her mammogram indicate she has dense breast tissue which may hide abnormalities & that she should contact her physician to discuss her personal risk factors and if supplementary screening may benefit her. The language is very simple, non-alarmist and straight forward. Have you read the actual text of the bill? I think you will find it a lot less “codifying” than you think: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0751-0800/sb_791_bill_20110909_amended_asm_v97.pdf
    Since we seem to agree on what the standard of care should be, meaning a woman’s right to know her breast density and it’s inherent risks, can’t you see the necessity of of this legislation?