Have state-level breast density reporting laws impacted screening ultrasound rates?

A majority of states have adopted breast density reporting laws, but it hasn’t led to a change in screening ultrasound ordering rates, according to nine years’ worth of data analyzed in the Journal of the American College of Radiology.

After looking at more than 12,500 preventative office visits included in the National Ambulatory Medical Care Survey, researchers also reported that the rate of screening breast ultrasound ordering by physicians has remained low over the study period.

“Even with more states adopting density notification laws, we observed no notable increasing trend in ultrasound ordering by physicians at preventive service visits,” wrote Geraldine J. Liao, MD, Virginia Mason Medical Center’s Department of Radiology in Seattle, and colleagues.

Liao and colleagues prefaced their study by noting that reporting laws “seem to have increased the likelihood” of patient and physician discussions on whether screening ultrasound is in their best interest, but national rates of ultrasound ordering remains unknown. Understanding these rates could contribute to the dialogue on whether screening ultrasound is an adequate supplemental screening modality, the group added.

The researchers looked at 12,787 visits performed from 2007 to 2015 in women aged 40 to 74 years without breast symptoms and signs or additional reasons requiring ultrasound. Of those women, 28.9% (3,370) underwent a breast exam, 22.1% (2,442) had a screening mammogram ordered and 3.3% (379) had screening ultrasound ordered.

Overall, they found the rate of ultrasound ordering remained unchanged after a state adopted breast density notification laws.

In fact, their subanalysis of 5,503 visits performed between 2012 and 2015 found screening ultrasound was ordered at 4.2% of postnotification law visits compared to 3.9% of prenotification law visits.

“One explanation may be that more time is required to observe changes in ordering behavior as a result of notification laws,” the researchers hypothesized. “The need for more time may be appropriate given that legislative mandates seem to outpace available evidence, with adoption of notification laws spreading despite a lack of strong guidelines in supporting supplemental screening ultrasound.”

The researchers did find, however, that ordering habits varied. Screening ultrasound was ordered more frequently for younger women (0.8 per 10-year increase in age), at urban practices and less frequently in institutions with computer-generated reminders to order screening tests.

“In summary, our analysis of nationally representative preventive service visits over nearly a decade demonstrates that the overall rate of screening ultrasound ordering has remained persistently low over time, the authors wrote.

Collectively, these findings underscore the need for additional work to advance understanding about physician ordering patterns and factors driving the use of supplemental screening ultrasound, which may or may not improve patient outcomes at the population level.”