Risk management interventions
To improve compliance with state breast density laws and limit legal exposure, a committee was formed at our institution from representatives of our health care system’s departments of ob/gyn, medicine, radiology, and risk management. This interdisciplinary cooperation resulted in implementation of several simple interventions.
(1) Providers who order screening mammograms have been educated regarding the significance of increased breast density on mammography and the corresponding state law. (2) Mammogram reports sent to ordering providers have been reformatted so that the breast density category is now more obvious and listed in the “Impression/Recommendations” section. (3) Result letters sent to patients now include the following wording: “The American College of Obstetricians and Gynecologists has addressed increased breast density, noting that no research studies have demonstrated earlier cancer detection or improved prognosis when additional breast imaging is obtained. ACOG advocates against routinely recommending additional breast imaging in otherwise asymptomatic women with increased breast density on mammogram. Some patients, however, wish to discuss increased breast density further or are interested in obtaining additional breast imaging. If you also do, given the complexity of the issue, you should schedule a breast density consult with your provider.”
Most providers do not comply with state laws requiring or implying patient notification and possibly offering the option of additional breast imaging. Simple interventions, such as clinician education and reformatting screening mammography result letters to both patients and providers, can improve compliance with breast density notification laws and limit legal liability.
The authors wish to acknowledge the assistance of Robin Metcalfe-Klaw, BS; Debra Copit, MD; Christopher Scaven, DO; Arnold Cohen, MD; and David Jaspan, DO.
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