Law Informs Patients of Added Breast Cancer Risk

JoAnn Pushkin introduced herself as a time bomb during a press conference with Assemblywoman Ellen Jaffee in Nyack Hospital's Krutz Auditorium Tuesday morning.

Pushkin is a breast cancer survivor and she was speaking about the risk of the disease returning, as it has once already. Her cancer went undetected for five years despite annual mammograms. Pushkin had dense breast tissue, which can mask tumors during a mammogram. 

"While my cancer was growing undetected those five years, the letters I received after my mammogram each of those years read normal negative," Pushkin said. "No sign of cancer. Six words. Not one word about breast density. Not one word that density can compromise a mammogram. Not one word suggesting another screening tool that might have detected my cancer at an earlier stage, sparing me the horror of eight surgeries, eight rounds of chemo, 30 rounds of radiation, a recurrence and now the rest of my life lived as a time bomb."

Pushkin now dedicates her time as an advocate for the cause of informing women of the risks involved with dense breast tissue and pushing for laws that ensure that women are told about their breast density when an issue is detected during a mammogram. In the Assembly, Jaffee sponsored New York's Breast Density Inform Law, which took effect in January. 

In the past, there was no requirement that women be informed if dense breast tissue is found during a mammogram. Now, the report from a mammogram that shows dense breast tissue must include the following.

"Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with increased risk of breast cancer. This information about your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your own risk. A report of your results was sent to your physician."

Jaffee cited a study by the Mayo Clinic in 2011 which showed cancer being missed on mammograms of 75 percent of women with dense breast tissue. On a mammogram, dense breast tissue and cancerous tumors both show up as white, so often the tumors will go undetected. Pushkin cited studies that have also shown a higher rate of breast cancer among women with dense tissue, showing it is an even higher indicator of risk than having a history of the disease among two family members. 

Pushkin said she found her tumor with a self exam. The tumor was large enough for her to feel it, though it did not show up on a mammogram taken that day. 

"Trying to find cancer in a dense breast is like trying to find a snowball in a blizzard," Pushkin said.

In the case of a woman who is at risk and may have a tumor masked from a mammogram by dense tissue, a tumor will show up much more clearly on a sonogram or ultrasound. Those and an MRI can be used as follow-up scans for women. As with any form of cancer, early detection is key in treating breast cancer. 


"Early detection saves lives," Jaffee said. "This law empowers women with dense breast tissue to get the information they need about their own breast density and to talk with their doctors to determine whether further screening is recommended."

Pushkin credited Jaffee for taking up the cause along with Senator John Flanagan (R-Islip), who sponsored the legislation in New York Senate. 

"She understood this legislation was about saving lives and that would happen by making sure this pertinent health information was in the hands of those who it would benefit most, women," Pushkin said.

She and Jaffee said the legislation initially included provisions for insurance coverage of further scans, but that met with strong resistance and was taken out to help get it passed and keep the conversation moving forward. Though they had not heard of private carriers denying coverage, Medicare patients often must wait to find out later if the scans beyond the mammogram are covered.

Pushkin, one of the co-founders of Density Education National Survivors' Effort (D.E.N.S.E.), said the group is gathering research to show insurance companies that it is more cost effective for them in the long run to pay for the additional scans rather than have to pay for more treatment for women whose breast cancer is not detected early enough. 

Pushkin said 12 states have adopted similar legislation, but she is also pushing for federal regulations. Congresswoman Rosa DeLauro (CT) and Congressman Steve Israel (NY) introduced the Breast Density and Mammography Reporting Act of 2011 in Oct, 2011, but there no federal law has been passed yet. 

Dr. Patricia Joseph, Director of Breast Cancer and Women's Health Prevention Services at Nyack Hospital, and radiologist Dr. Shari Goldman, Director of Breast Imaging at Hudson Valley Radiology Services and Nyack Hospital also spoke at Tuesday's press conference, which was held in recognition of Breast Cancer Awareness Month.