Breast density counseling requires improvement to address worries, concerns, questions

Key takeaways:

• Overall, 69%, 64% and 61% of women reported breast density worries/concerns, breast cancer risk or breast cancer screening option discussions.
• Clinician conversations varied significantly by race and ethnicity.

Clinician-patient breast density conversations need to address worries, concerns and unanswered questions, especially for Hispanic and Asian women and those with low literacy, according to survey findings published in JAMA Network Open.

“Prior research shows that less than half of women in the general population have conversations with their clinicians about breast density, and little is known about the content of the conversations that do occur,” Nancy R. Kressin, PhD, professor of medicine in the section of general internal medicine in the department of medicine at Boston University Chobanian & Avedisian School of Medicine, and colleagues wrote. “By understanding women’s experiences of such conversations, including whether they confer relevant information about breast cancer risk and screening options or address patients’ questions and concerns ... we can identify strengths and address potential deficits.”

Kressin and colleagues surveyed 770 U.S. women identified during a nationwide, population-based, random-digit dial telephone survey from July 2019 to April 2020. The 770 participants were aged 40 to 76 years, did not have a history of breast cancer, had undergone mammography in the previous 2 years and had heard the term “dense breasts” or “breast density.”

Participants were asked whether clinicians had asked them about breast cancer risk or their worries or concerns regarding breast density, whether clinicians had discussed mammography results or other breast cancer screening options and future risk for breast cancer, and the extent to which the clinician answered breast density questions.

Survey respondents varied in races and ethnicities, with 6% Asian, 16% Hispanic, 27% non-Hispanic Black, 41% non-Hispanic white and 10% of other races and ethnicities. Most women reported that their clinicians asked about breast cancer risk (88%), discussed mammography results (94%) and answered their breast density questions (81%). However, fewer women reported that clinicians asked them about their worries or concerns regarding breast density (69%), future breast cancer risk (64%) or other breast cancer screening options (61%).

Conversations with clinicians varied significantly by race and ethnicity. Non-Hispanic Black women reported being asked about breast cancer risk more often than non-Hispanic white women (OR = 2.08; 95% CI, 1.05-4.1; P = .04). Asian women less often reported being asked about worries or concerns (OR = 0.42; 95% CI, 0.2-0.86; P = .02), and both Hispanic (OR = 0.48; 95% CI, 0.27-0.87; P = .02) and Asian (OR = 0.28; 95% CI, 0.13-0.62; P = .002) women less often reported having their questions completely or mostly answered.

Researchers also noted that women with low literacy were less likely to report being asked about their worries or concerns (OR = 0.64; 95% CI, 0.43-0.96; P = .03), to have mammography results discussed (OR = 0.32; 95% CI, 0.16-0.63; P = .001) or to report that their questions were completely or mostly answered (OR = 0.51; 95% CI, 0.32-0.81; P = .004) compared with women with high literacy.

“Efforts to improve cultural competency, shared decision-making and counseling skills, especially when guidelines for care for women with dense breasts become more widespread, can potentially help close the remaining gaps in conversations about breast density,” the researchers wrote.