The Impact of Breast Density Information or Notification on Women’s Cognitive, Psychological, and Behavioral Outcomes: A Systematic Review

Abstract

Background Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological and behavioral outcomes. Methods Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. Results Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomised controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of healthcare professionals. Together the studies did however highlight that there is still limited awareness of BD in the community, especially in more socio-economic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. Conclusions There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.

Patient-Reported Factors Associated With Older Adults’ Cancer Screening Decision-making

“…A standardized template was developed and piloted to extract data, guided by previous systematic reviews. 17 , 18 , 19 Data were independently extracted by 2 authors (J.S. and K.M.G.)…”

Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter?

“…Overall, our findings add to the growing evidence supporting that DBN may increase general BD awareness, but pervasive disparities in awareness remains. 13,21,22 In addition, DBN alone is unlikely to increase knowledge of the implications of BD on breast cancer risk unless reinforced by direct communication of this information.…”

“…11 A recent review of 19 mostly cross-sectional studies revealed that general and personal awareness of BD varied substantially depending on the study population, and highlighted the need for additional research using prospective data. 13 Importantly, few studies have collected mammographic data in general screening populations to determine the groups of women who would receive notification of their BD as per legislation. As a result, the majority of studies cannot distinguish whether BD awareness and knowledge are due to women's receipt of and understanding of notification of personal BD information or reflect awareness from other sources of information including media, internet, friends, or healthcare providers.…”

A systematic assessment of online international breast density information

“…Other studies that have looked at readability of online patient education materials for breast density in the US have demonstrated similar findings [ [16] , [17] , [18] ]. Furthermore, studies have also consistently shown that breast density understanding and knowledge amongst women in the US continues to be low and variable [ 19 ]. Now, other countries around the world are beginning to notify or consider notifying women about their breast density, with many English-speaking countries with population-based screening programs having discussions and debates about how best to communicate and/or notify women about their breast density.…”