Breast Density: Why It Matters
 

A certified medically-sourced educational program for referring physicians, including family physicians and midlevel providers, Ob/Gyns, registered nurses, radiologists, and radiologic technologists.

	Format:	Online Course
	Physician Credit:	2.0 AMA PRA Category 1 $35  FREE
	RT Credit:	2.0 ARRT Category A credit $15   FREE

COURSE OVERVIEW
The two greatest risks for developing breast cancer are being female and getting older. But type of breast tissue should also be considered when personalizing a plan for the patient’s breast cancer screening exam.

Not only has breast density long been known to mask breast cancer on mammography, but breast density is an independent risk factor for the development of breast cancer. Increasing awareness about the importance of breast density necessitates new conversations between patients and their healthcare providers. Helping prompt these discussions are state laws requiring patients be provided some level of breast density information after undergoing mammography. To date, more than half of the states in the United States have passed legislation requiring at the least general notification about breast density, with some requiring that patients are informed about their breast tissue type.

This comprehensive educational program will inform referrers, including physicians, nurses, midlevel providers, radiologists, and radiologic technologists, on educating patients about the implications of dense tissue, including considerations for additional screening for patients who have heterogeneously dense or extremely dense breasts.

This medically-sourced activity includes:

• Discussion and illustrations of the four types of breast tissue
• Explanation of breast cancer risk, including disease-causing genetic mutations
• Recommendations for breast cancer screening, including for those who have dense breast tissue
• Review of factors that can affect breast density
• Assessment of several risk models for patient stratification and approaches for reducing risk
• A Screening Decision Support Tool to help craft an individualized breast cancer screening plan
• Review of breast imaging modalities for supplemental screening, including 3D mammography, ultrasound, MRI, molecular breast imaging/breast-specific gamma imaging, and contrast-enhanced digital mammography
• An update on breast density inform laws and efforts toward a national standard

EDUCATIONAL OBJECTIVES
At the conclusion of this activity, participants should be better able to:

• Describe the BI-RADS® categories of breast density used in mammographic reporting
• Identify the factors that affect breast density
• Discuss risks associated with having dense breasts
• Characterize outcomes from mammography in fatty and dense breasts
• Discuss the benefits and limitations of 3D mammography (digital breast tomosynthesis)
• Explain the benefits and disadvantages of supplemental screening with ultrasound for women with dense breasts
• Describe which women are recommended for screening with MRI and at what ages
• Identify other breast imaging technologies in development
• Review current state breast density inform laws

Accreditation & Credit
ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Pittsburgh and International Center for Postgraduate Medical Education. The University of Pittsburgh is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Physicians
The University of Pittsburgh designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SA-CME: This activity meets the criteria for self-assessment toward the purpose of fulfilling requirements in the American Board of Radiology (ABR) Maintenance of Certification Program.

The European Accreditation Council for CME (EACCME®)
The UEMS-EACCME® has mutual recognition agreements with the American Medical Association (AMA) for live events and e-learning materials. For more information go to http://www.uems.eu/uems-activities/accreditation/eaccme.

Radiologic Technologists
This program has been approved by the American Society of Radiologic Technologists (ASRT) for 2.0 hours of ARRT Category A continuing education credit.

Nurses
Most states allow nurses to use AMA PRA Category 1 Credit™ toward their relicensure. Nurses should refer to their state licensing body for specific requirements for nursing license renewal.

How to Participate
Once you are enrolled, you can return to this course any time by logging into your account at www.icpme.us

• Time to complete this educational activity is 2.0 hours. The posttest and evaluation are required to receive credit and must be completed online.
• Click ENROLL NOW - CONTINUE - CONFIRM ORDER - ACCESS COURSE NOW
• Download the PDF
• Read the entire educational activity

How to Receive Credit

• Log-in to your account at www.icpme.us
• Click on the course
• Once on the Course page, click the tabs to complete the POSTTEST and EVALUATION
• A passing grade of at least 75% is required to receive credit. You may take the test up to three times.
• Upon receipt of a passing grade, you will be able to print a certificate of credit from your account at www.icpme.us Your certificate will remain in your account as a record of credit earned at www.icpme.us

FACULTY
Wendie A. Berg, MD, PhD, FACR, FSBI, and Chief Scientific Advisor for DenseBreast-info.org, is Professor of Radiology at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC. Dr. Berg specializes in breast imaging and sees patients at Magee-Womens Hospital in Pittsburgh, PA. 

Dr. Berg has been the Principal Investigator of many important research studies in breast imaging, most notably with support of the Avon Foundation and the National Cancer Institute, the ACRIN 6666 protocol, which evaluated screening ultrasound and screening MRI in women with dense breasts. Dr. Berg has led important research evaluating positron emission mammography (PEM) and MRI in women with newly diagnosed cancer and is part of an outstanding team of physicians at UPMC who are evaluating tomosynthesis, fast MRI, contrast-enhanced mammography, and molecular imaging approaches to breast imaging.

Dr. Berg writes and co-edits one of the leading textbooks of breast imaging, Diagnostic Imaging: Breast (Amirsys; 3rd edition release in mid 2019) and has authored or coauthored more than 100 peer-reviewed research publications on breast imaging. 

JoAnn Pushkin, Executive Director of DenseBreast-info.org, is a patient/advocate, author, and speaker. She learned of her own breast density's masking effect on her mammogram after finding a palpable lump that went undetected by mammography several years in a row. She is also cofounder of the advocacy group DENSE (Density Education National Survivors’ Effort).

Ms. Pushkin's initiative and advocacy served as inspiration for New York State's Breast Density Inform bill, signed into law in July 2012. On the federal level, Ms. Pushkin led the efforts for both the introduction of the Federal Breast Density and Mammography Reporting Act, as well as the FDA’s Mammography Quality Standards Act regulatory amendment consideration.

Cindy Henke-Sarmento, RT(R)(M), BA, Technology Director of DenseBreast-info.org, is an entrepreneur, author, and co-owner of QSUM Biopsy Disposables, LLC. She has 29 years of experience in the mammography field, 22 years of specialized experience in breast care, and holds five patents. Ms. Henke-Sarmento led the initiative for the 2014 introduction of Colorado’s breast density reporting bill.

Disclosure of Conflicts of Interest
University of Pittsburgh requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to University of Pittsburgh policy. University of Pittsburgh is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty, planners, and managers have reported the following relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Wendie A. Berg, MD, PhD, FACR, FSBI, is Chief Scientific Advisor for DenseBreast-info.org and on the faculty in the Department of Radiology at the University of Pittsburgh, Magee-Womens Hospital.

Cindy Henke-Sarmento is co-owner of QSUM Biopsy Disposables, LLC.

JoAnn Pushkin has no disclosures to report.

The following planners and managers have reported no financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Victoria Phoenix, BS
Linda McLean, MS                                                          

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational references referring to technologies that are not yet approved by the FDA. The planners of this activity do not recommend the use of any product or device outside of the labeled indications.

This activity is for informational purposes only and is not intended to be a substitute for medical advice from a physician or to create a standard of care for health care providers.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Jointly Provided by

University of Pittsburgh, International Center for Postgraduate Medical Education, and DenseBreast-info.org.

DenseBreast-info.org is an educational resource developed to provide breast density information to both patients and health care professionals. This medically-sourced tool is the collaborative effort of world-renowned breast imaging experts and medical reviewers.  Dense-Breast-info, Inc. is a 501(c)(3) non-profit charity organized under the laws of New York State. All grants and donations help support the resources and initiatives to provide education about dense breasts to both women and their health care providers. The organization has received corporate unrestricted educational grants from The Avon Foundation for Women, Beekley Medical, CMR Naviscan, Densitas. GE Healthcare, Hologic, iCAD, QSUM Biopsy Disposables, Siemens Healthineers, Volpara Solutions, Wells Fargo

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.