Disseminating Supplemental Screening Resources for Providers Counseling Women with Dense Breasts
Date of Publication
Sally Herschorn, MD, FACR & Amy O'Meara, DNP, WHNP-BC, AGNP-C
Purpose.Vermont has a new mandatory breast density notification law that went into effect in January 2017. With the new legislation, mammographic density has a higher impact on patient management. However, 60% of facilities in states with a breast density notification law make no changes to their pre-existing practice concerning supplemental screening.Currently, there is no national consensus guideline available to aid with patient and provider decision-making regarding the recommendation of supplemental breast cancer screening for women with dense breasts. Patients should be properly counseled regarding the potential for false positive findings and the need for additional invasive procedures when pursuing additional screening modalities. Providers benefit from understanding the implications of dense breasts in order to provide appropriate counseling to women affected by breast density notification laws. The purpose of this project was to: 1) educate providers about important considerations when counseling individual patients with dense breasts, and 2) create a simple, easy to understand breast density resource for providers.
Methods.Online education materials for providers were developed in collaboration with a specialist in radiology. A provider online module was introduced in the Champlain Valley AHEC Newsletter, the UVM Medical Group News, the UVMMC Employee News, One, and as an announcement by the Vermont Nurse Practitioner Association.Provider comfort level in counseling patients about breast density and barriers to change were asked pre and post presentation of the educational materials. Additional teaching will be provided in the Primarily Vermont newsletter published by the University of Vermont Larner College of Medicine Office of Primary Care to target Vermont primary care providers. This additional provider resource and patient handout will appear in the Spring 2018 issue in the Primarily Vermont newsletter.
Results.Thirty-seven viewers for the online provider education power point about breast density information via YouTube were identified. Ten out of eleven survey participants responded that the presentation provided them with a resource that aided them in counseling women with dense breasts and helped to improve their comfort level. The target readers of the Primarily Vermontnewsletter are those who deliver and teach primary care.
Conclusion. The findings suggested that a lack of provider knowledge and lack of patient interest were the most common factors preventing providers from actively engaging patients in a discussion about their mammographic report and their breast density. Uncertainty over insurance coverage and high co-pay/deductibles are deterrents to follow-up supplemental screening using breast ultrasound or MRI. Further study is needed to educate women how breast density affects their mammography outcome as well as develop consensus on clinical guidelines to aid with patient and provider decision-making.
Charron, Heejung J., "Disseminating Supplemental Screening Resources for Providers Counseling Women with Dense Breasts" (2018). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 18.