Aims: To discuss how communication of breast cancer risk, via breast density notification, affects women’s anxiousness, understanding, and health behaviours in a population screening setting.
Methods: A multi-site, parallel-arm randomised controlled trial within the population-based breast screening program (BreastScreen) in Queensland, Australia. Women aged ≥40 years with dense breasts attending for screening were randomised to: no notification (standard care), notification plus written information, or notification plus digital (video) information. Psychosocial outcomes, including women’s self-perceived anxiousness, and health service intentions (8 weeks) and use (12 months) were measured. Qualitative interviews with a sub-set of women who indicated being anxious at 8 weeks were also conducted.
Results: Notification is associated with increased anxiousness amongst women at both 8 weeks and 12-months. Confusion was also consistently higher and there was no difference in women’s perceived feelings of being informed at both timepoints. At 8 weeks, notified women reported greater intentions to consult general practitioners and attend for supplemental screening; however, by 12 months there was no difference in GP consultations or supplemental screening uptake. Insights from women indicating greater anxiousness at 8 weeks revealed that while women value this information and feel empowered, immediate panic, worry and their previous perceived risk were challenged.
Conclusions: Notification of breast density may increase women’s anxiousness and confusion about their breast health without improving feelings of being informed or changing health-seeking behaviour. Therefore, communication of one risk factor for breast cancer alone as part of cancer screening may be an ineffective population strategy. Further research is needed to ensure evidence-based and equitable communication pathways about breast cancer risk to ensure benefit for all women.