Little is known about whether women residing in states with mandated dense breast notification (DBN) have improved awareness, knowledge, or discussion with their doctors, or whether there are disparities by sociodemographic characteristics. We conducted a cross-sectional, national telephone survey to assess the primary outcomes intended by DBN legislation: informing women about personal breast density, increasing awareness of its making effect and association with increased cancer risk, and prompting discussions with providers. Specific efforts were made to include women from all race/ethnic groups, education strata, and literacy levels.
Women aged >40 reporting a mammogram in <2 years, with no prior breast cancer diagnosis and having heard of the term ‘breast density’ were eligible. We conducted chi-square analyses for each outcome, comparing each by state DBN legislation status, age, income, race/ethnicity, health literacy, and two clinical breast cancer risk factors (family history, prior breast biopsy). Paired comparisons within each sociodemographic factor were tested using Z-tests (α=0.05). Multivariable, binary logistic regressions predicted each outcome using all variables above entered simultaneously as predictors. Secondary analyses tested whether sociodemographic differences in outcomes were moderated by state DBN status via interaction terms. The sample included 2,306 women; 1,782 residing in DBN states and 524 in non-DBN states. Half of the participants were white (50.3%), 23.1% non-Hispanic black, 14% Hispanic, 8.2% Asian, and 4.4% ‘other’. Women in DBN states were 1.55 (95% CI = 1.20, 1.99) times more likely to have received personal breast density information compared to women in non-DBN states after controlling for sociodemographic and risk factors. Those with lower incomes, Asian women, and those with lower health literacy were less likely to report receiving personal breast density information.
Overall, 39% had a discussion with their provider about breast density, with women in DBN states being 1.82 times more likely to have done so (95% CI= 1.40, 2.37).
There were no differences between women in DBN vs. non-DBN states related to knowledge of masking bias (OR=.99, 0.71, 1.39) or understanding that breast density is a cancer risk factor (OR=0.93, 0.71, 1.22). Hispanic and lower income women had less knowledge about these topics. Interaction models failed to reveal moderating effects of state DBN status, indicating that DBN legislation does not appear to be mitigating or worsening the observed sociodemographic differences. Findings suggest that mandated DBNs have had partial success informing women about their breast density. However, we saw few indications that DBNs increased knowledge and observed less knowledge among women with low income, racial/ethnic minority status and lower literacy. This ‘one size fits all’ policy approach to relaying breast density information appears to be inadequate in reducing disparities in breast density awareness and knowledge.
Citation Format: Nancy R. Kressin, Jolie Wormwood, Tracy A. Battaglia, Priscilla J. Slanetz, Christine M. Gunn. Mixed success and persistent disparities in outcomes related to breast density legislation: A national survey [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-079.