Knowledge of Density and Screening Ultrasound

Abstract

To determine breast density awareness and attitudes regarding supplemental breast ultrasound screening since implementation of the nation's first breast density notification law, Connecticut Public Act 09-41. A self-administered survey was distributed at a Connecticut academic breast imaging center between February 2013 and February 2014. Women with prior mammography reports describing heterogeneous or extremely dense breast tissue were invited to participate when presenting for screening mammography, screening ultrasound, or both. Data were collected on breast density awareness, history of prior ultrasounds, attitudes toward ultrasound and breast-cancer risk, and demographics. Data were collected from 950 completed surveys. The majority of surveyed women (92%) were aware of their breast density, and 77% had undergone a prior screening ultrasound. Forty-three percent of participants who were aware of their breast density also expressed increased anxiety about developing breast cancer due to having dense breast tissue. Caucasian race and higher education were significantly associated (p < 0.05) with knowledge of personal breast density (93% and 95%, respectively) and having a prior screening breast ultrasound (79% and 80%, respectively). Patients with less than a college degree (82%) were significantly more likely to rely exclusively on their provider's recommendation regarding obtaining screening ultrasound (p < 0.05). Breast density awareness is strongly associated with higher education, higher income, and Caucasian race. Non-Caucasian patients and those with less than a college education rely more heavily on their physicians' recommendations regarding screening ultrasound. Among women aware of their increased breast density, nearly half reported associated increased anxiety regarding the possibility of developing breast cancer.

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

“…All eligible studies are described, and their main findings summarised in Table 1. Studies were retrospective studies of medical or imaging records (18, 20, 27, 30, 34, 35, 37, 38), retrospective studies using sourced population datasets (26, 28), survey (or interview-based) studies (17, 19, 21–25, 29, 31, 32), and studies using micro-simulation modelling (33, 36). …”

“…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).…”

“…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). Survey-based studies generally had modest response rates (17, 19, 21–25, 29, 32). …”

“…These studies reported on various observed outcomes (18, 20, 26–30, 34, 35, 37, 38), perceived or expressed behavioural measures (17, 19, 21–25, 31, 32), or modelled outcomes (33, 36): study-specific results are detailed in Table 1. The group of studies exploring the effect of BD legislation on women, radiologists or physicians, reported on various domains such as knowledge, awareness, perceptions, attitudes and behaviour; or changes in practice or density reporting.…”

“…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). …”