Association Between Dense Breast Legislation and Cancer Stage at Diagnosis

Introduction: Many states have mandated breast density notification and insurance coverage for additional screening; yet, the association between such legislation and stage of diagnosis for breast cancer is unclear. This study investigates this association and examines the differential impacts among different age and race/ethnicity subgroups. Methods: The Surveillance, Epidemiology, and End Results database was queried to identify patients with breast cancer aged 40–74 years diagnosed between 2005 and 2016. Using a difference-in-differences multinomial logistic model, the odds of being diagnosed at different stages of cancer relative to the localized stage depending on legislation and individual characteristics were examined. Analyses were conducted in 2020–2021. Results: The study included 689,641 cases. Overall, the impact of notification legislation was not significant, whereas insurance coverage legislation was associated with 6% lower odds (OR=0.94, 95% CI=0.91, 0.96) of being diagnosed at the regional stage. The association between insurance coverage legislation and stage of diagnosis was even stronger among women aged 40–49 years, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.96) of being diagnosed at the regional stage and 12% lower odds (OR=0.88, 95% CI=0.81, 0.96) of being diagnosed at the distant stage. Hispanic women benefited from notification laws, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.97) of being diagnosed at distant stage. Neither notification nor supplemental screening insurance coverage legislation showed a substantial impact on Black women. Conclusions: The findings imply that improving insurance coverage is more important than being notified overall. Raising awareness is important among Hispanic women; improving communication about dense breasts and access to screening might be more important than legislation among Black women.



Work Title Association Between Dense Breast Legislation and Cancer Stage at Diagnosis
Open Access
  1. Chan Shen
  2. Roger W. Klein
  3. Jennifer L. Moss
  4. Daleela G. Dodge
  5. Alison L. Chetlen
  6. Kelly A. Stahl
  7. Shouhao Zhou
  8. Douglas L. Leslie
  9. Mack T. Ruffin
  10. Eugene J. Lengerich
License In Copyright (Rights Reserved)
Work Type Article
  1. American Journal of Preventive Medicine
Publication Date November 17, 2021
Publisher Identifier (DOI)
Deposited August 05, 2022




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Work History

Version 1

  • Created
  • Added 2021_Shen_AJPM_dense-breast-leg-cancer-stage.pdf
  • Added Creator Chan Shen
  • Added Creator Roger W. Klein
  • Added Creator Jennifer L. Moss
  • Added Creator Daleela G. Dodge
  • Added Creator Alison L Chetlen
  • Added Creator Kelly A. Stahl
  • Added Creator Shouhao Zhou
  • Added Creator Douglas L. Leslie
  • Added Creator Mack T. Ruff
  • Added Creator Mack T. Ruffin
  • Added Creator Eugene J. Lengerich
  • Published
  • Updated Publication Date Show Changes
    Publication Date
    • 2021-01-01
    • 2021-11-17
  • Deleted Creator Mack T. Ruff
  • Renamed Creator Alison L. Chetlen Show Changes
    • Alison L Chetlen
    • Alison L. Chetlen
  • Updated Creator Mack T. Ruffin
  • Updated Creator Eugene J. Lengerich