A closer look at women's concerns on breast density in clinician discussions

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A study found variations in discussions about breast density based on race and ethnicity, leading researchers to urge enhanced cultural competency and shared decision-making to bridge critical gaps in breast density conversations.

A closer look at women's concerns on breast density in clinician discussions | Image Credit: © Kzenon - © Kzenon - stock.adobe.com.

A closer look at women's concerns on breast density in clinician discussions | Image Credit: © Kzenon - © Kzenon - stock.adobe.com.

Women often have unaddressed worries or concerns about breast density after discussion with clinicians, according to a recent study published in JAMA Network Open.

Takeaways

  1. The study reveals that discussions about breast density between women and clinicians are often underreported, with research indicating that less than half of women discuss this topic with their healthcare providers.
  2. Despite the potential impact of dense breast tissue on breast cancer risk and screening sensitivity, there is a lack of data on the content of discussions between women and clinicians regarding breast density, highlighting a significant knowledge gap in this area.
  3. The study identifies sociodemographic disparities in discussions about breast density. Factors such as age, income, education level, and race/ethnicity influence the likelihood of women being asked about breast cancer risk and concerns related to breast density by their clinicians.
  4. The findings suggest a need for improved cultural competency among healthcare providers, as discussions about breast density vary based on race and ethnicity.
  5. The study highlights areas for improvement in discussions about breast density, emphasizing the importance of addressing concerns and providing comprehensive information to women, particularly those with dense breast tissue.

Breast cancer risk is increased by dense breast tissue, while screening mammography sensitivity is decreased. Dense breast notifications (DBNs) are required in 38 states and the District of Columbia, recommending women with dense breasts discuss risks with their physicians for more informed decisions.

Research has indicated under half of women discuss breast density with their clinicians, and data on the content of these conversations is lacking. To evaluate women’s conversations with clinicians on breast density risk, investigators conducted a telephone cross-sectional, national, random-digit dial survey study.

Questions within the SSRS Omnibus survey were included in the analysis. Participants included women in the United States with no prior history of breast cancer who received a mammography within the previous 2 years and had heard the term “dense breasts” or “breast density.”

Participants were asked about breast cancer risk and worries or concerns about breast density. Discussions occurred about mammography results, other options for breast cancer screening, and future breast cancer risk. Patients also reported if clinicians answered their questions on breast density completely, mostly, somewhat, a little, or not at all.

Investigators also evaluated whether participants lived in states with required DBNs, as well as age, educational level, income, race and ethnicity, and literacy. Breast cancer risk factors were controlled by asking patients if they had a first-degree relative with a past breast biopsy or diagnosis of breast cancer.

There were 770 patients included in the final analysis, 82% of which lived in states with required DBNs. Of patients, 47% were aged 50 to 64 years, 24% 40 to 49 years, and 29% 65 years and older. An income below $50,000 was reported in 48% of women, and a high school education or less in 23%.

Being asked about breast cancer risk by clinicians was reported by 88% of participants, with these questions asked more often to women with a college degree or higher. Questions about breast cancer risk were more often asked to non-Hispanic Black women than Hispanic women, at 92% and 82% respectively. 

The odds of questions about breast cancer density were 2.08 times greater in non-Hispanic Black women than non-Hispanic White women. Patients with a family history of breast cancer of breast biopsy were also more likely to be asked about risks.

Clinicians asking about worries or concerns about breast density was reported by 69% of women. Questions were less common in women aged 65 years or older compared to younger women, as well as in women with incomes below $50,000. 

These questions were also received less by Asian women compared to non-Hispanic White women and non-Hispanic Black women, at 52%, 70%, and 71% respectively. Eighty-one percent of participants reported their clinician mostly or completely answered their questions about breast density, with variations based on race and ethnicity.

Answered questions were reported by 86% of non-Hispanic White patients, 79% of non-Hispanic Black patients, and 74% of Hispanic patients. These results indicated variations in breast cancer discussion based on race and ethnicity, as well as areas with needed improvement. 

Investigators recommended efforts to improve cultural competency, counseling skills, and shared decision-making be implemented to remove gaps in discussions about breast density.

Reference

Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Sociodemographic variations in women’s reports of discussions with clinicians about breast density. JAMA Netw Open. 2023;6(11):e2344850. doi:10.1001/jamanetworkopen.2023.44850

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