Abstract PD4-07: Impact of breast density legislation on Hispanic / Latinas in the Northeast, US
Authors: Jones BA , Philpotts L , Cooley R , Silber A , Epstein L , Claye E 
Published: May 2016

Abstract
Objective: Changes in health care delivery and policies resulting from translational research efforts are intended to benefit a broad segment of the affected population. Yet, uptake of new approaches may not occur at the same level and/or pace in all groups, inadvertently increasing disparities in cancer outcomes. Our objective is to explore the impact of recently enacted legislation associated with routine mammography screening on Hispanic /Latino women living in Connecticut. Background: Breast densities are the non-fat (epithelial and stromal) breast tissue observable on screening mammograms. They are associated with a 4 to 6 fold increase in breast cancer risk and complicate the reading of screening mammograms, resulting in lowered sensitivity. Connecticut (CT) and many other states have enacted legislation requiring supplemental testing to be offered to women with dense breasts. Per CT statute, insurance companies must cover the cost of ultrasound screening of an entire breast/breasts for women with heterogeneously or extremely dense breasts. Additionally, personal information on breast density must be included in the mailed result following a screening mammogram. The intent is to improve early detection in women with dense breasts and to increase awareness of the greater risk of associated with dense breast tissue. Methods: After this law was enacted in 2008, we undertook a large prospective study of mammography screening in community based Hispanic/Latinas. We enrolled women seeking care in primary health care settings in the 4 CT cities with the largest H/L populations. Eligible women were ages 40-75, self-identified as H/L, and had negative history for breast cancer or breast biopsy. With 75% participation for baseline interview and 98% consent for medical record review, we report baseline interview data and mammography results (medical records) over a 2.5 - 4 year follow-up on 668 H/L women, ages 40-79, living in CT at the time of enrollment (2009-2011). Results: The women in this study were mostly foreign or Puerto Rican born (84%), lower socioeconomic status (51% with household incomes less than $10,000 per year; 54% less had than a high school education) than the general population; median age was 51. Nearly half (46.0%) reported no usual care provider. Only 14% reported speaking English "very well". Most women reported that they received a mammogram in the previous year (65.0%). 21.4% of women met the criteria for receiving additional bilateral ultrasound testing due to heterogeneously dense (19.2%) or extremely dense (2.3%) breast tissue on screening mammograms occurring during follow up. Of the 128 women eligible for follow-up ultrasound, 18 (14%) received this exam. Conclusion: Although state law requires patient notification of breast density and insurance coverage for supplementary bilateral ultrasound tests in women with moderate to extremely dense breasts, our results show low uptake in Hispanic/Latino women in CT. In this largely foreign born, English second language population, effective communication regarding breast cancer risk, breast density, and the availability of follow-up ultrasound or other testing may represent a significant cancer care challenge.
Citation Format: Jones BA, Philpotts L, Cooley R, Silber A, Epstein L, Claye E. Impact of breast density legislation on Hispanic / Latinas in the Northeast, US. [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 PD4-07.