Ingman Wendy V, Richards Bernadette, Street Jacqueline M, Carter Drew, Rickard Mary, Stone Jennifer, Dasari Pallave
Adelaide Medical School based at The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA 5011, Australia.
Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia.
J Clin Med. 2020 Mar 3;9(3):681. doi: 10.3390/jcm9030681.
Breast density, also known as mammographic density, refers to white and bright regions on a mammogram. Breast density can only be assessed by mammogram and is not related to how breasts look or feel. Therefore, women will only know their breast density if they are notified by the radiologist when they have a mammogram. Breast density affects a woman's breast cancer risk and the sensitivity of a screening mammogram to detect cancer. Currently, the position of BreastScreen Australia and the Royal Australian and New Zealand College of Radiologists is to not notify women if they have dense breasts. However, patient advocacy organisations are lobbying for policy change. Whether or not to notify women of their breast density is a complex issue and can be framed within the context of both public health ethics and clinical ethics. Central ethical themes associated with breast density notification are equitable care, patient autonomy in decision-making, trust in health professionals, duty of care by the physician, and uncertainties around evidence relating to measurement and clinical management pathways for women with dense breasts. Legal guidance on this issue must be gained from broad legal principles found in the law of negligence and the test of materiality. We conclude a rigid legal framework for breast density notification in Australia would not be appropriate. Instead, a policy framework should be developed through engagement with all stakeholders to understand and take account of multiple perspectives and the values at stake.
乳腺密度，也称为乳房X线摄影密度，指的是乳房X线照片上的白色明亮区域。乳腺密度只能通过乳房X线照片来评估，与乳房的外观或触感无关。因此，只有在进行乳房X线检查时放射科医生告知，女性才会知道自己的乳腺密度。乳腺密度会影响女性患乳腺癌的风险以及筛查性乳房X线检查检测癌症的敏感性。目前，澳大利亚乳房筛查机构以及澳大利亚和新西兰皇家放射科医师学院的立场是，如果女性乳房密度高，不会告知她们。然而，患者权益倡导组织正在游说政策变革。是否告知女性其乳腺密度是一个复杂的问题，可以在公共卫生伦理和临床伦理的背景下进行探讨。与乳腺密度告知相关的核心伦理主题包括公平护理、患者决策自主权、对医疗专业人员的信任、医生的护理职责以及与乳腺密度高的女性的测量和临床管理途径相关证据的不确定性。关于这个问题的法律指导必须从过失法中的广泛法律原则和重要性测试中获得。我们得出结论，在澳大利亚建立一个严格的乳腺密度告知法律框架是不合适的。相反，应该通过与所有利益相关者合作来制定一个政策框架，以理解并考虑到多种观点和利害关系中的价值观。
