Abstract: Examining the Necessity of Legislation Mandating Communication about Breast Density

◆ Daniel Totzkay, West Virginia University

Breast density is an emerging public health concern related to the prevention and detection of breast cancer. Breast density is defined as the proportion of breast tissue to breast fat, breasts being “mammographically dense” when there is a greater proportion of tissue to fat. Dense tissue is determined by a radiologist when interpreting a mammogram, as the tissue appears white and can complicate the identification of tumors and other abnormalities.

In an effort to boost the public’s knowledge about breast density and encourage women to be more active in their breast cancer prevention, 38 states have passed laws mandating the communication of breast density information within a woman’s mammogram lay report. If a mammogram is determined to not show cancer but to have dense tissue present, a block of text is embedded into a woman’s mammogram report that tells her while no cancer was found, dense tissue can make it difficult to identify tumors and is associated with increased cancer risk. Then, the notification suggests taking this information to the woman’s health care provider and asking what other cancer screening options are available for them. As states pass this legislation, providers and public health officials have voiced concern over the notifications due to their potential to cause anxiety and higher-cost care among women, in addition to there being no clear follow-up for providers who receive this information.

In a quasi-experiment between states with and without breast density notification laws, women likely to receive a notification (i.e., aged 40-50 years who have recently received a mammogram and have no cancer history) (N=190) reported whether they had heard about breast density and from where they had received that information. Most reported never hearing about breast density, with no statistically significant difference between states with versus without notification legislation. Those who had heard about breast density reported hearing about it from health care providers or medical staff, interpersonal sources such as coworkers, family, and friends, and mediated sources such as the Internet and the news.

Then, an experiment was conducted by exposing a similar sample of women (N=540) either to a mammogram report with a breast density notification embedded or a control mammogram report with no density information. After viewing the notification, women reported a greater intention to speak with their health care provider about breast density, greater self-efficacy regarding that conversation, greater worry about breast density, and more accurate knowledge regarding breast density’s complication of mammogram interpretation and that other options were available for cancer screening. Women also believed cancer was present, despite the letter explicitly stating no cancer was found.

Taken together, these findings suggest women already know some details about breast density, perhaps in part due to dense breast notifications. However, these data suggest other sources of density information that should be examined, as well as potential negative consequences of feeling worried after reading the notification. This means the legislation continuing to be passed that mandates this communication and encourages patient-provider communication about the topic should be examined more critically.