Details such as age, language/s spoken, and personal and family history of cancer were collected and women were randomised to either standard “control” care (no notification of breast density in their results letter), notification of breast density plus written information about breast density and its implications (intervention 1), or notification of density plus a link to online video based information (intervention 2). After 8 weeks, women reported their prior awareness of breast density, self-rated health and wellbeing, health literacy, and preferences for more or less healthcare. They were also surveyed about their psychological response to their results (feeling anxious, confused, or informed) and their intentions to talk to their GP and pursue additional screening.
Compared with the control group, women notified of their breast density had greater odds of feeling anxious (control: 18%; intervention 1: 20.8%; intervention 2: 20.5%) and were significantly more confused (control: 2.7%; intervention 1: 11.5%; intervention 2: 9%) about what to do. Both notified groups also had significantly higher intentions to talk to their GP about their screening results (intervention 1: 22.8%; intervention 2: 19.4%) compared with the control arm (12.9%), although most women did not intend to have additional screening.
And notified women did not feel better informed to make decisions about their breast health compared with controls.
The authors acknowledge several limitations including the low proportion of women who did not access or watch the additional video-based information in full, as well as the low proportion of women from non-English speaking backgrounds in the trial. However, they say this is the first international trial to rigorously evaluate the immediate consequences of breast density notification, providing key evidence for breast cancer screening programmes outside of the US contemplating introducing density notification or legislation.
Dr Nickelconcludes: “Internationally, we encourage governments to consider gathering additional data on beneficial and equitable clinical pathways and to plan the provision of breast density information carefully to ensure that the benefits of breast density notification outweigh potential harms for all women.”
Source: The BMJ / University of Sydney