Dense Breast Notification Laws Falling Short of Hopes

January 13, 2021
Whitney J. Palmer

More women are learning about their breast density levels, but the rates still remain low.

Dense Breast Notification (DBN) legislation – the laws requiring that women be notified after a mammogram about their level of breast density – are working, just not as well as hoped.

According to a nationwide study conducted by investigators from Boston University School of Medicine (BUSM), women who live in states with DBNs are more well informed about breast density, and more of them are talking to their doctors about it. But, the overall rates still remain low.

To find out why, the team, led by Nancy Kressin, Ph.D., BUSM professor of medicine, looked at whether sociodemographic characteristics could be playing a role. They published their findings recently in the Journal of the American College of Radiology.

“We examined self-reported receipt of personal breast density information, breast density discussion with providers, knowledge about density’s masking effect, and association with increased breast cancer risk by state legislation status and women’s sociodemographic characteristics,” she said, noting this study is one of the first such national surveys. “Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.”

Related Content: Breast Density Laws: Are They Working? Do Online Education Resources Help?

Currently, 38 states have DBN laws, but existing studies have found that most are written at a literacy level that could be too high for most women, making it difficult for them to fully understand what their notification letters mean.

Based on a survey of 2,306 women, Kressin’s team determined that 57 percent received information about their personal breast density level. Women who lived in DBN states were 1.5 times more likely to get the notification, but even still older African American and Asian women who were both of lower income and lower health literacy were less likely.

In addition, women receiving a DBN were 1.75 times as likely to talk with their doctors about breast density. But, overall, only 39 percent of women had this conversation – older and Asian women were less likely, and women with high literacy or prior biopsy were more likely.

Women’s knowledge around breast density was a bit more complicated, Kressin explained. According to their analysis, whether a state has a DBN was not associated with any differences in breast density knowledge among women. But, Hispanic, lower-income, and low-health literacy women did know less about how dense breast tissue can conceal existing cancers on mammograms.

These results show that a more varied approach is needed to informing women breast density and what it means for their risk of breast cancer. This includes giving physicians more training and education so they can have tailored discussions to meet the individual woman’s needs.

“These findings suggest that ‘one size does not fit all’ when breast density information is conveyed and suggests that the message or the mode of dissemination may need to be tailored for different populations to achieve knowledge equity,” Kressin explained.

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