April 26, 2016
Along with their screening mammogram results, women in nearly half of U.S. states also receive notifications of breast density. Dense breasts can mask cancer on mammography, and are an independent cancer risk factor. However, the text of dense breast notifications (DBNs) may affect women's ability to understand their message. In a Research Letter featured in the April 26 issue of JAMA, Nancy R. Kressin, PhD, HSR&D Research Career Scientist awardee and part of the Center for Healthcare Organization and Implementation Research (CHOIR), and colleagues discuss the content, readability, and understandability of DBNs sent to women following screening mammography.
As of January 1, 2016, 24 states require DBNs. Study investigators examined DBN characteristics across states, except for Delaware where legislation was insufficiently detailed. Results show a wide variability in dense breast notifications across states, and most are difficult to read and understand. Further, most DBNs are written at a literacy level exceeding that of the state's population, suggesting that many women will find the information difficult to understand. This may create uncertainty for women attempting to make personalized decisions about supplemental breast screening, and may heighten disparities in breast cancer outcomes. The authors suggest that future efforts focus on enhancing the understandability of DBNs so that all women are clearly and accurately informed about their density status, its effect on their breast cancer risk, and the harms and benefits of supplemental screening.