General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

Abstract

ObjectivesTo understand general practitioners’ (GPs’) awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women.DesignQualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis.SettingAustralia.ParticipantsAustralian GPs (n=30).ResultsGPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD.ConclusionsAustralian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.

Australian General Practitioners’ Current Knowledge, Understanding, and Feelings Regarding Breast Density Information and Notification: A Cross-Sectional Study

“…Regardless, even among this group of GPs who had self-selected to participate in the current study and had a higher level of awareness or experiences with breast-density-related issues, the interest and need for further education and training is clear. This is in line with our earlier qualitative study findings [ 16 ]. This highlights the need for widespread education campaigns, especially if breast density notification is to be introduced through BreastScreen programs.…”

“…Nickel et al previously conducted a qualitative study into the views and perception of Australian GPs regarding breast density and potential notification [ 16 ]. The findings from this study pointed to GPs’ limited knowledge about breast density and mixed views towards notification, especially when clear guidelines in managing breast density are lacking [ 17 ].…”

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

“…An Australian study from the state of Western Australia where they currently notify women of their breast density found that half of women notified consulted or intended to consult with their general practitioner (GP), and of those, 50% were referred for supplemental screening and 20% reported having an ultrasound [ 24 ]. Of concern, however, is that important gaps still exist in GP knowledge about breast density and confidence in having discussions with women about the implications [ 25 , 26 ], and the current lack of evidence-based management guidelines for GPs.…”

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

“…38 Previous studies have shown that GPs in Australia and primary care practitioners in the US had limited knowledge about breast density, were uncertain about how to manage care for women with dense breasts, and needed support and training. 39,40 With an expected increase in GP consultations related to breast density and cancer risk if notification is introduced, it will be crucial to ensure GPs have the knowledge and resources to counsel individuals about breast density and the pros and cons of supplemental screening, including in relation to psychological well-being. Informed and shared decision-making models based on evidence, patient values and goals, and joint decisions may help to reduce worries and other adverse psychological outcomes.…”