Imagine a 57-year-old woman, let's call her Maria, who has just opened a letter about her mammography results. She had previously had several mammograms, but this time the brand new information read: “Your breasts are dense”.
While the letter reassures her that dense breasts are normal, it also indicates that breast cancer could be difficult to see on a mammogram.
Maria is confused about what to do next and wonders if she ought to be anxious. Does he have to see his GP?
Maria could also be fictional but she reflects the outcomes of the primary trial of its kind We publish today.
We inform women that they've dense breasts together with their mammogram results are more confused and anxious, feel less informed, and are more inclined to see their GP for advice.
Remind me, what's breast density?
Dense breast tissue appears white on a mammogram and might hide (or mask) cancer, which also appears white.
Dense breasts are quite common. about 25–40% Women are considered dense breasts.
Breast density is One of many Independent risk aspects for breast cancer. After Years of consumer advocacyMore women are being told about their breast density after they get their results from breast cancer screenings.
The idea is easy: Tell women whether or not they have dense breasts — something that may increase the chance of cancer and make a mammogram difficult to read — so that they can resolve whether to get additional testing, comparable to an ultrasound or MRI.
Informing women about breast density is now legislated The United Stateswas suggested Australiaand can be being considered in other jurisdictions, e.g Britain.
This is despite a scarcity of strong evidence on whether the advantages of reporting breast density at screening outweigh the potential harms for ladies, and the impact on health services.
What we did and what we got
Our case Co-designed with BreastScreen Queensland. From September 2023 to July 2024, we randomized 2,401 women (average age 57) who had a transparent mammogram (their mammogram didn't show cancer), but had three varieties of dense breasts:
- Controls: no reports of dense breasts (standard care)
- Intervention 1: Additional written information in a booklet along with the breast density notification letter as a part of the screening results.
- Intervention 2: Notification of breast density as a part of screening results plus a link to additional information in a web based video.
Eight weeks after screening, we reported that girls with dense breasts felt more anxious and confused about what to do about their breast health in comparison with the control group.
They also didn't feel well informed to make decisions about their breast health, and were more inclined to debate it with their GP.
We didn't follow the participants long enough, nor was the trial specifically designed to see if informing women about their breast density led to additional cancers being detected.
The trial also had some limitations. For example, the proportion of girls from non-English speaking backgrounds was lower.
However, that is the primary randomized trial worldwide to evaluate the immediate effects of breast density reporting on women within the context of mammography screening.
It provides evidence for breast screening programs internationally to rigorously consider the potential impact of such notification.
What next?
In Australia, where breast density reporting is now really helpful, it can be crucial to acknowledge that the subject of breast density could be confusing and a few women may feel anxious.
Communication about breast density, including public messaging, should give attention to density amongst the numerous risk aspects for breast cancer and that there are other potentially modifiable ways to scale back a girl's overall risk.
This includes maintaining a healthy weight, being physically energetic, reducing alcohol intake, and never smoking. Messaging also needs to emphasize that mammograms remain one of the best screening method for breast cancer in most girls, even in the event that they have dense breasts.
GPs have to be prepared Conversations with women about breast density and their overall risk of breast cancer. This includes discussing the professionals and cons of additional screening (through ultrasound, MRI or contrast-enhanced mammograms) that may detect cancers found on mammograms.
But even this just isn't uncomplicated. For example, while there may be evidence Additional screening will detect more cancersthere may be currently no evidence that this can occur Reduce death from advanced breast cancer or breast cancer.
Additional screening may cause unintended effects comparable to false positives.
Additional screening can be not equitable for all women resulting from out-of-pocket costs and limited availability through public services.
We need higher pathways to evidence-based, equitable care in Australia so the advantages of informing women about their breast density really outweigh any negative consequences for ladies and the health system. These pathways have to be evaluated to make sure that they're feasible, acceptable, effective and equitable.