Win for Women in DC

Breast cancer devastated Anne Kalosh’s family. When Anne was a teenager her mom died from breast cancer. Two of her mom’s sisters, Anne’s aunts, also passed away from breast cancer. Anne hoped that she would be spared.

Anne started having regular mammograms when she was 32 years old. To this day, she has never felt any abnormal lumps and her mammograms have never shown any signs of cancer. Anne’s doctor, Dr. Rachel Brem, told Anne that she had a serious risk factor for breast cancer - dense breast tissue. Because of this, Dr. Brem ordered ultrasounds for Anne, in addition to Anne’s annual mammograms. In September of 2018, Dr. Brem found Anne’s breast cancer on an ultrasound – after a normal mammogram.  Unlike her mother, Anne’s breast cancer was found early and at a treatable stage.

Dr. Brem, Director of Breast Imaging and Intervention at the George Washington Medical Faculty Associates, thought it was imperative to notify Anne about her dense breast tissue and ordered extra tests. Maybe that is because Dr. Brem, herself, is no stranger to breast cancer hidden in dense breast tissue.

When Dr. Brem was 12 years old, her 33-year-old mother was diagnosed with late-stage breast cancer.

This experience inspired Dr. Brem to go to medical school and specialize in breast imaging. Dr. Brem has become a world-renowned physician but is also known as a compassionate doctor who treats every patient like family.

Among other practices, she tested potential, new equipment on herself after her patients went home.  One night, in 1996, Dr. Brem was testing a new ultrasound machine on herself. She discovered two things. The first was which machine she wanted to buy for her patients and the second was her own breast cancer. She was 37 years old, had three young daughters, and had had a normal mammogram two weeks earlier. It showed nothing because, like many of her patients, Dr. Brem had extremely dense breast tissue.

Anne and Dr. Brem are here today because they had critical information about their dense breast tissue. But, until 2019, not everyone in DC was so lucky. On March 22, 2019, that changed.

On March 22nd, the DC Council passed the “Breast Density Screening and Notification Act.”

This law requires that all mammogram reports in DC include information about breast density for women impacted by this risk factor for breast cancer. The percentage of women with heterogeneously dense breast tissue in the United States is 40 percent. Extremely dense breast tissue is found in about 10 percent of women.

Breast density is the ratio of fibroglandular tissue to fatty breast tissue. The more fibroglandular tissue, the denser the breast. Women with fibroglandular density are 4.7 times more likely to get breast cancer, but their cancers are harder to see on mammograms. Because dense breast tissue puts women at a higher risk of cancer, women with dense breasts often need other screenings to find earlier, more curable breast cancers.

But the D.C. law did not stop with notification.

Notification is not enough. The law also requires insurance coverage for necessary and lifesaving screenings for women with dense breast tissue. Without insurance coverage, women, especially lower-income women, cannot act on this critical information. Thirty-eight other states have dense breast notification laws, but only seven require insurance coverage.

Breast density is also a social justice issue. When a woman finds out that she has dense breasts but cannot afford necessary screenings, she is stuck.  Stuck with the knowledge that she is 4.7 times more likely to get breast cancer. Stuck knowing that if she has breast cancer, that cancer is 20 percent less likely to show up on her regular mammogram. Stuck, because she cannot pay.  Now she will get the lifesaving screenings she deserves.

Now, many more women will survive breast cancer because they will be able to access the screenings that saved the lives of Anne and Dr. Brem. The D.C. Breast Density and Notification Act should be heralded as an example of what’s needed across the U.S. It is time for women, especially lower-income women, to get the preventative breast care they need and deserve.

Now more women will know about a serious and widespread risk factor for breast cancer. But we are not done. We need to use the DC law to pave the path towards a time when every American woman, regardless of her income, can access life-saving screenings. When this happens, more women will survive breast cancer, more women will make progress, and more women will be here to fight for the rights they need and deserve.