Explaining between-race differences in African-American and European-American women's responses to breast density notification

Abstract

Background: Prior research shows between-race differences in women’s knowledge and emotions related to having dense breasts, thus suggesting that between-race differences in behavioral decision-making following receipt of breast density (BD) notifications are likely. Guided by the theory of planned behavior, this study examined differences in emotion-related responses (i.e., anxiety, worry, confusion) and behavioral cognition (e.g., intentions, behavioral attitudes) following receipt of BD notifications among African American (AA) and European American (EA) women. This study also examined whether race-related perceptions (i.e., discrimination, group-based medical mistrust), relevant knowledge and socioeconomic status (SES) explained the between race differences. Method: Michigan women (N = 457) who presented for routine screening mammogram and had dense breasts, no prior breast cancer diagnoses, and had screen-negative mammograms were recruited from July, 2015 to March 2016. MANOVA was used to examine between race differences in psychological responses (i.e., emotional responses and behavioral cognition), and a multi-group structural regression model was used to examine whether race-related constructs, knowledge and SES mediated the effect of race on emotional responses and behavioral cognition. Prior awareness of BD was accounted for in all analyses. Results: AA women generally reported more negative psychological responses to receiving BD notifications regardless of prior BD awareness. AA women had more favorable perceptions related to talking to their physicians about the BD notifications. Generally, race-related perceptions, SES, and related knowledge partially accounted for the effect of race on psychological response. Race-related perceptions and SES partially accounted for the differences in behavioral intentions. Between-race differences in emotional responses to BD notifications did not explain differences in women’s intentions to discuss BD notifications with their physicians. Conclusions: Future examinations are warranted to examine whether there are between-race differences in actual post-BD notification behaviors and whether similar race-related variables account for differences.

Prior breast density awareness, knowledge, and communication in a health system–embedded behavioral intervention trial

“…Ensuring that patients are prepared to engage in shared decision making about breast health management when they are alerted to their density status is essential because of the lack of density‐specific clinical guidelines. If patients do not understand breast density and how it affects their cancer risk and screening options, density disclosure could lead to anxiety, confusion, inaction, or inappropriate use of health care services . Clarifying awareness, knowledge, and communication about breast density in community practice settings is, therefore, essential for informing work to maximize benefit and minimize harm from routine density disclosure.…”

“…If patients do not understand breast density and how it affects their cancer risk and screening options, density disclosure could lead to anxiety, confusion, inaction, or inappropriate use of health care services. [12][13][14] Clarifying awareness, knowledge, and communication about breast density in community practice settings is, therefore, essential for informing work to maximize benefit and minimize harm from routine density disclosure.…”

The impact of legislation mandating breast density notification – Review of the evidence

“…On the other hand, several studies solely described or explored factors (such as women’s or health practitioners’ knowledge) post-enactment of BD legislation (17, 19, 22, 23, 25, 32), or described post-legislation test performance or utilisation (18, 27, 37). The two studies based on established simulation models used several sources of data to estimate comparative effectiveness and cost-effectiveness of supplemental screening for women with dense breasts (33, 36).…”

“…Effect on women: variable findings across studies on parameters such as concern about risk from BD, knowledge or awareness of BD, response to (or recall of) BD notification message, and intention to screen or interact with the health system (17, 18, 21, 22, 25); overall, these suggest that BD information or notification to women needs to be both specific in content and carefully crafted, and that the relatively modest proportion of women with dense breasts taking up supplementary screening (18, 35) may vary based on communication method (18). …”

“…An emerging area of research on the impact of BD legislation comprises qualitative and quantitative studies that explore the effect of BD notification on women (17, 18, 21, 22, 25), primary care and other physicians (19, 23, 32), and radiologists (21, 24, 28, 29, 31, 34). While some of these studies are limited to small or selected samples or surveys with modest responses, they highlight areas of uncertainty (for example, lack of consensus amongst health professionals on the most appropriate approach for managing women with dense breasts), and unmet knowledge and support needs amongst women receiving notifications, as well as amongst health providers.…”