Australia’s rollout of breast density notification appears to create more uncertainty and concern among women instead of improving clarity.
Higher confusion and anxiousness are emerging among women as breast density notification is introduced across Australia, despite the intention to improve understanding of breast health. Between a 25 and 40 percent of women have denser breast tissue, which can make mammograms less effective at detecting cancer. ().
New findings from specialists at the University of Sydney indicate that these notifications often leave women feeling unsure and worried about what dense breast tissue means for their health.
TOP INSIGHT
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Breast density notifications meant to guide women actually leads to more confusion and anxiety for many receiving them.
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Breast Density Risks and Screening Challenges
The notification initiative aims to alert women that having dense breast tissue is linked to a higher chance of developing cancer while also emphasizing that dense tissue can obscure cancer signs during a mammogram.
Breast density notification is currently being implemented nationwide in Australia, and although it is already required in the United States, strong evidence on its real-world impact has been lacking until now.
Dr. Brooke Nickel from the School of Public Health, lead author of the British Medical Journal publication, explained that these notifications are built on the belief that providing information will help women make informed decisions about their health.
Women’s Response to Notification Messages
She noted, “In theory this is a really good thing but what we found in practice was that breast density notification made women more confused and anxious about their breast health. Women also did not feel more informed.”
For those with dense breasts, extra screening options such as ultrasound, magnetic resonance imaging, and contrast-enhanced mammography can discover cancers. However, these methods usually involve out-of-pocket expenses, and solid evidence on long-term advantages, including reduced mortality or avoiding unintended issues like widening health inequality, is still limited.
Randomized Trial on Breast Density Notification
To assess how these notifications affect women, researchers carried out a randomized control trial with 2,401 participants across 13 BreastScreen locations in Queensland between September 2023 and July 2024. Within the trial, women found to have dense breasts were assigned to one of three outcomes.
The first group received a breast density notification in their screening results letter along with a leaflet offering additional details about dense breast tissue. The second group had a notification included in the letter along with a link to an online video containing health-literacy-sensitive information. The third group, serving as the control, did not receive any breast density notification in their results letter.
Increased Confusion, Rising Anxiousness
Notably, 11.5 percent and 9 percent of women in the two informed groups felt confused after receiving a breast density notification alongside a normal result, compared with only 2.7 percent of women in the control group.
Feelings of anxiousness about what steps to take for their breast health were also higher among the women who received notifications, reaching 20.8 percent in the first outcome group and 20.5 percent in the second, compared with 18 percent in the control group.
Both groups that received notifications also showed a greater likelihood of planning to talk to their general practitioner about their results, with 22.8 percent and 19.4 percent respectively, compared with 12.9 percent in the control group.
Challenges in Providing Clear Breast Density Guidance
Dr. Nickel emphasized, “Creating confusion and worry for women about their breast health is not a good outcome. And while it might seem positive that notified women want to seek further advice from their GP, there is currently limited evidence-based clinical pathways that GPs can offer, with most of the suggested recommendations leaving women with out-of-pocket costs.”
She added that worldwide, governments are encouraged to gather further information on clinical pathways that are both beneficial and equitable, and to carefully develop programs for sharing breast density information so that any benefits clearly outweigh potential harms for all women.
Reference:
- Impact of population based breast density notification: three arm screening programme embedded randomised controlled trial(https://www.bmj.com/content/391/bmj-2024-083649)
Source-Eurekalert