Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

Dolan, Hankiz; McCaffery, Kirsten; Houssami, Nehmat; Cvejic, Erin; Brennan, Meagan; Hersch, Jolyn; Dorrington, Melanie; Verde, Angela; Vaccaro, L; Nickel, Brooke

doi:10.1001/jamanetworkopen.2022.16784

Cited by 8 publications

(8 citation statements)

References 40 publications

(92 reference statements)

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“…This was mainly driven by the psychological impact of the possibility or increased risk of cancer. In previous studies, it has been shown that providing breast density notification and accompanying information can improve knowledge about the reduced sensitivity of mammography in dense breasts and the increased risk of breast cancer; however, this may also increase women’s anxiety and confusion [ 13 , 21 ]. In order to mitigate any unintended outcomes, such as anxiety, the phrasing of the BD notifications should be carefully crafted to enhance the understanding of the notifications so that the women are accurately informed [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Australian Women’s Responses to Breast Density Information: A Content Analysis

Pandya

Liu

Dolan

et al. 2023

IJERPH

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Breast density (BD) is an independent risk factor for breast cancer and reduces mammographic sensitivity. This study explored women’s responses and intentions if notified that they had dense breasts. Methods: Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40–74. Results: Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they “wouldn’t worry about it too much”. Discussion: These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.

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Section: Discussionmentioning

confidence: 99%

Australian Women’s Responses to Breast Density Information: A Content Analysis

Pandya

Liu

Dolan

et al. 2023

IJERPH

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“…The results of our earlier qualitative studies 22 , 23 and experimental RCT 24 — co‐designed with input from BreastScreen collaborators, as well as local and state community and BreastScreen Queensland panels that included Aboriginal and Torres Strait Islander women — informed the RCT study design and the additional information provided.…”

Section: Methodsmentioning

confidence: 99%

Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial

Nickel,

Ormiston‐Smith,

Hammerton

et al. 2023

Medical Journal of Australia

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BackgroundRobust evidence regarding the benefits and harms of notifying Australian women when routine breast screening identifies that they have dense breasts is needed for informing future mammography population screening practice and policy.ObjectivesTo assess the psychosocial and health services use effects of notifying women participating in population‐based breast cancer screening that they have dense breasts; to examine whether the mode of communicating this information about its implications (print, online formats) influences these effects.Methods and analysisThe study population comprises women aged 40 years or older who attend BreastScreen Queensland Sunshine Coast services for mammographic screening and are found to have dense breasts (BI‐RADS density C or D). The randomised controlled trial includes three arms (952 women each): standard BreastScreen care (no notification of breast density; control arm); notification of dense breasts in screening results letter and print health literacy‐sensitive information (intervention arm 1) or a link or QR code to online video‐based health literacy‐sensitive information (intervention arm 2). Baseline demographic data will be obtained from BreastScreen Queensland. Outcomes data will be collected in questionnaires at baseline and eight weeks, twelve months, and 27 months after breast screening. Primary outcomes will be psychological outcomes and health service use; secondary outcomes will be supplemental screening outcomes, cancer worry, perceived breast cancer risk, knowledge about breast density, future mammographic screening intentions, and acceptability of notification about dense breasts.Ethics approvalGold Coast Hospital and Health Service Ethics Committee (HREC/2023/QGC/89770); Sunshine Coast Hospital and Health Service Research Governance and Development (SSA/2023/QSC/89770).Dissemination of findingsFindings will be reported in peer‐reviewed journals and at national and international conferences. They will also be reported to BreastScreen Queensland, BreastScreen Australia, Cancer Australia, and other bodies involved in cancer care and screening, including patient and support organisations.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12623000001695p (prospective: 9 January 2023).

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“…Full methods of the trial are reported elsewhere. 11 Data were analysed using generalised linear regression models with a modified Poisson approach (Poisson distribution with a log-link and robust standard errors) to permit estimation of adjusted relative risks and corresponding 95% confidence intervals for intention to seek supplemental screening (ultrasound or MRI), relative to all other screening intention options. Given the exploratory nature of the analysis, potential covariates were first included in a simple adjustment model, including the covariate and the randomised condition (adapted letter from WA and HL sensitive letter).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with women's supplemental screening intentions following dense breast notification in an online randomised experimental study

et al. 2022

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Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.

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Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

Cited by 8 publications

References 40 publications

Australian Women’s Responses to Breast Density Information: A Content Analysis

Australian Women’s Responses to Breast Density Information: A Content Analysis

Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial

Factors associated with women's supplemental screening intentions following dense breast notification in an online randomised experimental study

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