From the July 2022 issue of HealthCare Business News magazine

Research, including our own, suggests that awareness of breast density has increased over the past decade but there is room for improvement. In a study we conducted of 1,528 women from 8 mammography facilities in states with varying density notification laws we found that the majority (76%) of women correctly thought they had dense breasts while only 14% of women correctly knew they had non-dense breasts. Interestingly, 34% of women with non-dense breasts thought they had dense breasts. It’s not clear why women tend to frequently think they have dense breasts and if increasing density awareness contributes to that. Breast density may change over a woman’s lifetime, typically resulting in a reduction in density after menopause, which may result in different density notifications or none at all. While state policies are in place a woman who moves from one state to another may encounter entirely different language about her breast density if a notification is sent. Further, Sprague et al. found the chance of a woman being told she has dense or non-dense breasts varies widely by which radiologist interprets her mammogram. It is easy to see why women may be confused about their density and why clinician engagement in discussions on the topic are vital.

We also found that women with non-dense breasts who lived in states that sent notifications to both those with dense and non-dense breasts were significantly more likely to know their breast density. While this is not surprising, there may be quality of life benefits to density education for all women, such as reduced worry about cancer. We found that women who thought they had non-dense breasts had less worry about screening and less desire for additional screening.


Supplemental screening has potential benefits of detecting cancer not seen on a mammogram and reducing worry, but also has potential for harms. These include unnecessary callbacks (further diagnostic work-up in the absence of a cancer diagnosis), and overdiagnosis (diagnosing a cancer that will not cause symptoms or death during a woman's lifetime), which are difficult concepts to convey in written notifications in a manner that is tailored to a wide range of reading levels. The balance of benefits and harms may be better expressed by clinicians in one-on-one conversations with their patients and with clinical decision support tools. In our study, we found that lower education level was associated with a significantly lower chance of a woman knowing her breast density. This suggests that density notification has the potential to increase disparities in breast cancer screening if notifications are not designed with lower reading levels in mind and if clinicians do not engage in personalized conversations about breast density with their patients. Clinical decision support tools will also need tailoring to meet the needs of multiple socio-demographic groups.

July 2022 Magazine

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