Nancy R. Kressin, PhD VA Medical Center, Jamaica Plain Campus Boston, MA 

Awareness of Breast Density Importance Varies by State Laws and Social Factors Interview with:

Nancy R. Kressin, PhD VA Medical Center, Jamaica Plain Campus Boston, MA 

Dr. Kressin

Nancy R. Kressin, PhD
VA Medical Center, Jamaica Plain Campus
Boston, MA What is the background for this study?

Response: State-level legislation requires informing women about breast density (BD) with mammogram results, to increase awareness of BD’s tendency to mask cancers on mammography, its association with increased breast cancer risk, and to encourage women to discuss personal risk and supplemental screening with physicians.

The Food and Drug Administration is currently developing dense breast notification (DBN) language for use nationwide; information about effects of state DBNs could be informative for FDA’s language. What are the main findings?

Response: The proportion of women who had heard of breast density was 76%, with no differences by state DBN status.  In bivariate and multivariate results, women with less education, lower incomes and non-white race/ethnicity were less likely to have heard of breast density. Among women who had heard of breast density, bivariate analyses showed that the percentage of women endorsing that BD means how breasts feel when one touches them was less (better) among white women, those residing in DBN states, with higher incomes, and college degrees; state DBN status and race/ethnicity remained significant in multivariate analyses. There were no bivariate state DBN status differences regarding women’s knowledge of whether dense breasts increase risk of breast cancer; less than half of women recognized this risk.  There were no differences in having discussed BD with a doctor, but among those not yet having had such discussions, all results indicated that women residing in DBN states, with higher incomes and non-Hispanic ethnicity were less likely to plan such discussions. What should readers take away from your report?

Response: This national survey found few differences in outcomes by state DBN status but numerous differences disadvantaging lower socioeconomic status and racial/ethnic minority women.  Results identified greater anxiety and confusion about breast density among black women, which has also been found by others. The differences in outcomes we observed for vulnerable women suggest that future DBNs should address these gaps to optimize outcomes.  Given the discordance of state DBNs’ literacy levels and readability with their populations’ levels (which we previously found), the present findings underscore the importance of crafting federal DBNs in clear, plain language, and rigorously testing the proposed language with diverse samples, to ensure that the positive goals of increased breast density awareness, knowledge, and discussions with physicians about personal risk for breast cancer, and supplemental screening appropriate to such risk, are achieved for all women. What recommendations do you have for future research as a result of this work? 

Response: We recommend that future research rigorously evaluate the effects of different ways of wording dense breast notifications, and whether the effects vary by women’s sociodemographic characteristics, to ensure that the information is understandable to all women and that the notifications lead to their desired effects (and not to other, unintended effects).

No disclosures 


Differences in Breast Density Awareness, Knowledge, and Plans Based on State Legislation Status and Sociodemographic Characteristics

Kressin, N.R., Wormwood, J.B., Battaglia, T.A. et al. J GEN INTERN MED (2019).


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Last Updated on December 19, 2019 by Marie Benz MD FAAD