WASHINGTON, D.C.—Breast cancer screening presents a legal minefield for providers, and breast density notification laws are set to add another wrinkle to the already complex situation, according to a presentation at the annual meeting of AHRA.

The U.S. is the most litigious country in the world, and breast cancer claims make up the greatest number of malpractice suits, according to presenter Bonnie Rush, RT, president of Breast Imaging Specialists in San Diego, Calif., and AHRA advocate liaison to Are You Dense Advocacy Inc.

One of the issues is a misconception among the public about what mammography screening can actually accomplish, Rush said. Many people feel that mammography screening is more definitive than it really is, and that radiologists should be held responsible in all cases where cancers are missed or there is a delay diagnosis.

Rush suggested that radiologists need to assume the role of educator, making sure to get the word out about the potential for false positives and false negatives to curb misconceptions. “We need to make sure that [patients] don’t end up…with an unreasonable expectation. They become disappointed, they then become angry, and then they litigate.”

As breast density notification legislation spreads through the states, the legal calculus will begin to change, added Rush. Judgment of negligence is based on whether a provider performed the standard of care, and with breast density notification laws now passed in 19 states containing more than half the U.S. population, it will soon be standard of care to notify women if they have dense breasts. Women with dense breasts who are not notified about supplemental screening options and then develop cancer will be able to point to the notification standard in other states and ask why she wasn’t informed.

About 40 percent of women have dense breasts, which both puts them at a higher risk of cancer and also obscures cancer on mammography.