Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Department of Psychology, University of New Hampshire, Durham.
JAMA Netw Open. 2023 Nov 1;6(11):e2344850. doi: 10.1001/jamanetworkopen.2023.44850.
Breast density notifications advise women to discuss breast density with their clinicians, yet little is known about such discussions.
To examine the content of women's reports of breast density discussions with clinicians and identify variations by women's sociodemographic characteristics (age, income, state legislation status, race and ethnicity, and literacy level).
DESIGN, SETTING, AND PARTICIPANTS: This US nationwide, population-based, random-digit dial telephone survey study was conducted from July 1, 2019, to April 30, 2020, among 2306 women aged 40 to 76 years with no history of breast cancer who underwent mammography in the prior 2 years and had heard the term dense breasts or breast density. Results were analyzed from a subsample of 770 women reporting a conversation about breast density with their clinician after their last mammographic screening. Statistical analysis was conducted in April and July 2023.
Survey questions inquired whether women's clinicians had asked about breast cancer risk or their worries or concerns about breast density, had discussed mammography results or other options for breast cancer screening or their future risk of breast cancer, as well as the extent to which the clinician answered questions about breast density.
Of the 770 women (358 [47%] aged 50-64 years; 47 Asian [6%], 125 Hispanic [16%], 204 non-Hispanic Black [27%], 317 non-Hispanic White [41%], and 77 other race and ethnicity [10%]) whose results were analyzed, most reported that their clinicians asked questions about breast cancer risk (88% [670 of 766]), discussed mammography results (94% [724 of 768]), and answered patient questions about breast density (81% [614 of 761]); fewer women reported that clinicians had asked about worries or concerns about breast density (69% [524 of 764]), future risk of breast cancer (64% [489 of 764]), or other options for breast cancer screening (61% [459 of 756]). Women's reports of conversations varied significantly by race and ethnicity; non-Hispanic Black women reported being asked questions about breast cancer risk more often than non-Hispanic White women (odds ratio [OR], 2.08 [95% CI, 1.05-4.10]; P = .04). Asian women less often reported being asked about their worries or concerns (OR, 0.42 [95% CI, 0.20-0.86]; P = .02), and Hispanic and Asian women less often reported having their questions about breast density answered completely or mostly (Asian: OR, 0.28 [95% CI, 0.13-0.62]; P = .002; Hispanic: OR, 0.48 [95% CI, 0.27-0.87]; P = .02). Women with low literacy were less likely than women with high literacy to report being asked about worries or concerns about breast density (OR, 0.64 [95% CI, 0.43-0.96]; P = .03), that mammography results were discussed with them (OR, 0.32 [95% CI, 0.16-0.63]; P = .001), or that their questions about breast density were answered completely or mostly (OR, 0.51 [95% CI, 0.32-0.81]; P = .004).
In this survey study, although most women reported that their clinicians counselled them about breast density, the unaddressed worries or concerns and unanswered questions, especially among Hispanic and Asian women and those with low literacy, highlighted areas where discussions could be improved.
乳腺密度通知建议女性与临床医生讨论乳腺密度，但对这种讨论知之甚少。
研究女性报告的与临床医生讨论乳腺密度的内容，并确定女性社会人口统计学特征（年龄、收入、州立法状况、种族和族裔以及文化程度）的差异。
设计、地点和参与者：这是一项美国全国性的、基于人群的、随机数字拨号电话调查研究，于 2019 年 7 月 1 日至 2020 年 4 月 30 日期间进行，对象为 2306 名年龄在 40 至 76 岁之间、无乳腺癌病史、过去两年内接受过乳房 X 光检查且听说过致密乳房或乳腺密度的女性。对 770 名在最近一次乳房 X 光筛查后与临床医生就乳腺密度进行过对话的女性进行了亚组分析。统计分析于 2023 年 4 月和 7 月进行。
调查问题询问女性的临床医生是否询问过乳腺癌风险或她们对乳腺密度的担忧或顾虑，是否讨论过乳房 X 光检查结果或其他乳腺癌筛查选择，以及临床医生回答有关乳腺密度问题的程度。
在对 770 名（358 名[47%]年龄在 50-64 岁；47 名亚裔[6%]，125 名西班牙裔[16%]，204 名非西班牙裔黑人[27%]，317 名非西班牙裔白人[41%]，77 名其他种族和族裔[10%]）结果进行分析的女性中，大多数报告说她们的临床医生询问了乳腺癌风险（88%[670 名/766 名]），讨论了乳房 X 光检查结果（94%[724 名/768 名]），并回答了患者有关乳腺密度的问题（81%[614 名/761 名]）；较少的女性报告说，临床医生询问了她们对乳腺密度的担忧或顾虑（69%[524 名/764 名]），未来的乳腺癌风险（64%[489 名/764 名]），或其他乳腺癌筛查选择（61%[459 名/756 名]）。女性报告的对话差异显著，按种族和族裔划分；非西班牙裔黑人女性报告临床医生询问乳腺癌风险的频率高于非西班牙裔白人女性（比值比[OR]，2.08[95%CI，1.05-4.10]；P=0.04）。亚裔女性较少报告被询问其担忧或顾虑（OR，0.42[95%CI，0.20-0.86]；P=0.02），而西班牙裔和亚裔女性较少报告她们的问题得到了完全或大部分回答（亚裔：OR，0.28[95%CI，0.13-0.62]；P=0.002；西班牙裔：OR，0.48[95%CI，0.27-0.87]；P=0.02）。文化程度较低的女性比文化程度较高的女性更不可能报告被询问对乳腺密度的担忧或顾虑（OR，0.64[95%CI，0.43-0.96]；P=0.03），报告与她们讨论了乳房 X 光检查结果（OR，0.32[95%CI，0.16-0.63]；P=0.001），或报告她们的问题得到了完全或大部分回答（OR，0.51[95%CI，0.32-0.81]；P=0.004）。
在这项调查研究中，尽管大多数女性报告说她们的临床医生对她们进行了乳腺密度咨询，但未解决的担忧或顾虑以及未回答的问题，尤其是在西班牙裔和亚裔女性以及文化程度较低的女性中，突出了需要改进讨论的领域。
