TESTIMONY OF JOHN BENSON, M.D.
IN OPPOSITION TO LD 550,
AN ACT Requiring Communication of
Mammographic Breast Density Information to Patients
Joint Standing Committee on Health and Human Services
Room 209, Cross State Office Building
Wednesday, March 22, 2017, 9:00 a.m.
Good morning Senator Brakey, Representative Hymanson, and Members of the Joint Standing Committee on Health and Human Services. I am John Benson of Bar Harbor, a physician and radiologist at Mt Desert Island Hospital in Bar Harbor where I am Medical Director of the Breast Health Center. I am president of the Maine Radiological Society and a member of the Maine Medical Association. Today I am speaking in opposition to LD 550, An Act Requiring Communication of Mammographic Breast Density Information to Patients.
The Maine Medical Association is a professional organization representing more than 4000 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine and promote the health of all Maine citizens. The Maine Radiological Society is a chapter of the American College of Radiology, a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of medical imaging care.
LD 550 would prescribe exactly what a radiologist must say to a patient about the matter of breast tissue density. There are two problems with that. The first is that as physicians we often modify the words we use so as to communicate most effectively with each individual patient. Such an approach is much better than “one size fits all” language established by the Legislature. If the exact language is put into law, what happens when medical science advances and things change? The legal requirement would not be medically appropriate, but doctors would be required to keep using it until the Legislature changed it…which brings me to my second point.
The language this bill would require is incorrect. “Molecular breast imaging” is not the same thing as a “digital mammogram,” yet the bill seems to say that they are the same. Furthermore, the language is contrary to the American College of Radiology appropriateness criteria. As one of our member radiologists said recently, “This wording is sure to cause a huge amount of stress and consternation among low risk women with dense breasts, as they will have to make a decision on whether or not to pay for an expensive MRI out of pocket or live in fear that they may be harboring a breast cancer, as the insurance companies will not cover it.”
The American College of Radiology, the national standard-setter on radiologic matters, is the organization that should (and does) suggest to radiologists how they can most effectively communicate with their patients. With all due respect, the Maine Legislature does not have the expertise necessary to do that, and you definitely should not “cast in stone” the words doctors must say to their patients. We take our work and our duties to our patients very seriously, and we should not be prevented from using our best medical judgment to help our patients.
The issue raised in LD 550 has already been addressed by a rather large, state resource intensive project back in 2013 where all stakeholders were present. The task force, which I chaired, officially recommended to all of Maine’s radiologists, hospital and other mammography facilities, mammography technologists and administrators that all patients should be informed of their breast density. Also the ordering providers were educated regarding the significance of breast density. The bill at that time was LD 1886. Participants included national density notification advocacy groups and Dr. Nancy Capello who started the nationwide movement years ago in Connecticut. Another woman from the New York chapter of her organization was part of the task force. We had primary care physicians, radiologists, including myself and several of my colleagues, the Maine Hospital Association, Maine Breast Cancer Coalition, etc. As follow-up we did many personal appearances around the state speaking to various organizations including the Maine Osteopathic Association, the annual conference attended by nearly all the mammography technologists in the state, and others. We believe there is reasonable compliance with this recommendation and that a mandate is not needed.
On behalf of the Maine Radiological Society and the Maine Medical Association, we ask that you vote “Ought Not to Pass” on LD 550. I would be pleased to address any questions you may have.