Breast density notification: evidence on whether benefit outweighs harm is required to inform future screening practice

Nickel, Brooke; Farber, Rachel; Brennan, Meagan; Hersch, Jolyn; McCaffery, Kirsten; Houssami, Nehmat

doi:10.1136/bmjebm-2020-111364

Cited by 18 publications

(11 citation statements)

References 21 publications

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“…7 This has escalated concern about the issue in the scientific and broader community, 7 8 particularly given concern that evidence supporting widespread BD notification is weak, and—for any individual woman—the balance between potential benefits and harms of notification is unclear. 9 There are no uniform recommendations for women with dense breasts in regard to supplemental screening. This is due to very limited evidence for any benefit in long-term outcomes such as advanced breast cancer incidence and mortality.…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

et al. 2021

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ObjectivesTo understand general practitioners’ (GPs’) awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women.DesignQualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis.SettingAustralia.ParticipantsAustralian GPs (n=30).ResultsGPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD.ConclusionsAustralian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.

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Section: Introductionmentioning

confidence: 99%

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

et al. 2021

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“…what it is, how it is measured and what it means for women – there were only a few websites that directly stated the benefits and harms of measuring and knowing breast density. Most of the focus of benefits and harms were around supplemental screening, however, given the limited evidence of benefit, it is important for information to also mention whether breast density should even be measured and/or notified to women in the first place and the evidence (or lack of evidence) to support this [ 36 ]. Interestingly a recent focus group study of Australian women who had little to no previous awareness or knowledge of breast density found that information on harms including overdiagnosis did not seem to have a strong swaying effect on women's views about breast density, although the expressed desire for more information, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…This demonstrates that direct claims and recommendations are being made about breast density but not always supported by evidence, which could be incorrectly adding credibility to the information or their arguments. Also, there seemed to be quite a bit of variability in the estimates or data provided which is understandable given the variability in the current evidence surrounding breast density but may add to confusion for women [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

A systematic assessment of online international breast density information

Nickel

Copp

et al. 2022

The Breast

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“…80 Nickel et al have raised concerns about breast tissue density notification and concluded that evidence on whether benefit outweighs harm is required to inform future screening practice. 81 Consensus on the balance of benefits versus harms has not yet been established. Although evidence is rapidly emerging, more studies are underway to evaluate sustainability and cost effectiveness.…”

Section: Limitationsmentioning

confidence: 99%

Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada

et al. 2021

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Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists’ screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.

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Breast density notification: evidence on whether benefit outweighs harm is required to inform future screening practice

Cited by 18 publications

References 21 publications

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

A systematic assessment of online international breast density information

Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada

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