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Dense Breast Notification Legislation: Recorded Effects and Future Recommendations


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According to findings published by Kressin et al in the Journal of the American College of Radiology, women living in states where dense breast notifications are legislatively mandated had higher rates of being informed about personal breast density and of having had breast density discussions with providers, though rates were low overall.

Dense breast notifications are defined as a written message to a woman after a mammogram with information about breast density. The goal of the notification is to motivate the patient to speak with her doctor about her personal risk of breast cancer and determine if supplemental screening for breast cancer is appropriate. Dense breast notifications are mandated in more than 38 states, and the U.S. Food Drug Administration is developing standardized language for a federal/nationwide notification.

Prior research showed many states’ dense breast notifications are written at a higher literacy level than possessed by women residing in that state, which suggests that some women may find it hard to understand the notifications. Researchers have now conducted one of the first national surveys to ask women about their reactions to these notifications and to understand their knowledge, awareness, and plans about breast density, while examining whether these findings vary among women of different race/ethnicity, income, and health literacy levels.

“These findings suggest that ‘one size does not fit all’ when breast density information is conveyed and suggests that the message or the mode of dissemination may need to be tailored for different populations to achieve knowledge equity.”
— Nancy Kressin, PhD

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Study Findings

In this new study, the researchers investigated whether there were differences in breast density awareness, knowledge, or discussions among women residing in states with vs without dense breast notification legislation or based on sociodemographic characteristics.

Although the study did show that dense breast notification laws were associated with more women receiving information about personal breast density and an increased likelihood of having a discussion with a health-care provider about breast density, women of color, those with lower incomes, and those with lower health literacy were generally less likely to have received personal breast density information or to have spoken with their providers. However, while dense breast notification laws were not generally associated with differences in women’s knowledge about risks associated with breast density, Hispanic women, lower-income women, and women with low health literacy reported less knowledge regarding density’s tendency to mask cancers on mammograms, and were less likely to recognize the increased cancer risk associated with dense breasts.

“These findings suggest that ‘one size does not fit all’ when breast density information is conveyed and suggests that the message or the mode of dissemination may need to be tailored for different populations to achieve knowledge equity,” explained corresponding study author Nancy Kressin, PhD, Professor of Medicine at Boston University School of Medicine.

Given that women in states with dense breast notification laws were twice as likely to speak with their doctors, the researchers believe physicians seem a natural conduit for tailored discussions that meet each woman’s needs. However, Dr. Kressin pointed out that prior studies have shown that for this approach to be most effective, further physician education will be needed.

Disclosure: For full disclosures of the study authors, visit jacr.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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