Sydney School of Public Health (A27), Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia.
Department of Radiology, University of Washington School of Medicine, Department of Health Services, University of Washington School of Public Health, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, 98109, Australia.
Breast. 2018 Dec;42:102-112. doi: 10.1016/j.breast.2018.09.001. Epub 2018 Sep 11.
Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. The enactment of BD legislation in a majority of states in the USA mandating notification of risks associated with BD directly to women undergoing mammography has catapulted interest in BD among women, physicians, and policymakers. We therefore report a descriptive review of the evidence on the impact of enactment of BD legislation. Based on 22 eligible studies, we identified four broad themes of research: studies of the impact on screening rates, most showing increased utilisation of supplemental screening; studies exploring the effect on women, radiologists, or primary physicians (reporting heterogeneous effects on knowledge, awareness, perceptions, attitudes and behaviour; and changes in practice); few studies assessing the population impact (effect on screening outcomes or breast cancer stage); and studies of costs highlighting the economic burden from supplemental screening. Given that many of the studies were retrospective single institution studies (comparing pre- and post-legislation) or small surveys with a paucity of population-level studies, we highlight areas meriting additional research. The information described in this review can inform research priorities where BD legislation has been introduced and can be used to guide world-wide policy or practice decisions where BD legislation may be under debate or contemplation.
乳腺密度（BD）是乳腺癌的一个独立危险因素，降低了乳房 X 光检查的敏感性。美国大多数州颁布了 BD 立法，要求对接受乳房 X 光检查的妇女直接告知与 BD 相关的风险，这极大地提高了妇女、医生和政策制定者对 BD 的兴趣。因此，我们报告了对 BD 立法影响的证据进行的描述性综述。基于 22 项合格研究，我们确定了四个广泛的研究主题：对筛查率影响的研究，大多数研究表明补充筛查的利用率增加；研究探索对妇女、放射科医生或初级医生的影响（报告知识、意识、看法、态度和行为的异质性影响以及实践的变化）；评估人群影响（对筛查结果或乳腺癌分期的影响）的研究较少；以及强调补充筛查的经济负担的成本研究。鉴于许多研究是回顾性的单机构研究（比较立法前后）或缺乏人群研究的小型调查，我们强调了值得进一步研究的领域。本综述中描述的信息可以为已经引入 BD 立法的地区提供研究重点，并可用于指导全球政策或实践决策，这些决策可能正在讨论或考虑 BD 立法。
