Abstract C095: Dense breast notification, breast density awareness, and breast cancer-related cognition and emotions in a predominantly Hispanic screening population
Authors: Agovino Mariangela D. , Rodriguez Carmen B. , Terry Mary Beth , Shelton Rachel , Schmitt Karen , Desperito Elise , Wei Ying , Kukafka Rita , Tehranifar Parisa 
Published: September 2020

Abstract
Dense breast notification laws enacted in over 35 states mandate written disclosure of information to women with high mammographic breast density (high MBD), as defined by the heterogeneously or extremely dense breast classification of the Breast Imaging-Reporting and Data System. In most states, the notification informs women with high MBD about higher breast cancer (BC) risk and lower sensitivity of mammography in women with dense breasts. It also advises women to consult their doctors about their risk and any need for additional imaging. We examined personal history of high MBD in relation to breast density awareness, and BC-related emotional (BC worry) and cognitive (perceived BC risk and mammogram benefits) factors. We further investigated whether these associations varied by race/ethnicity, educational attainment and language proficiency in 649 women presenting for screening mammography (40-60 years, 80% Hispanic, 47% high school or less education, 70% Spanish speaking). Only 24% of women reported having heard of breast density (awareness), of whom, 68% correctly reported a personal history of high MBD, but only 23% reported having initiated a discussion about breast density with their physicians. In multivariable models, breast density awareness was higher for women with a history of high MBD (OR=2.4, 95% CI: 1.5, 4.0), a history of follow-up after screening mammography for any reason (e.g., multiple recalls vs none OR=4.2, 95% CI: 1.9, 9.6), and family history of BC (OR=2.0, 95% CI: 1.0, 3.9). In the same multivariable model, awareness was lower for women who were foreign-born (e.g., OR=0.3, 95% CI: 0.2, 0.6 vs U.S.-born), Spanish speaking (OR=0.2, 95% CI: 0.1, 0.4 vs English speaking), and had lower education (e.g., OR=0.1, 95% CI: 0.1, 0.3 high school or less vs college vs higher degree). High MBD was associated with increased breast density awareness in all racial/ethnic, nativity, educational, and language proficiency groups. Breast cancer-related psychological outcomes differed only by breast density awareness but not by high MBD history. Women with breast density awareness reported higher worry (e.g., OR=2.5, 95% CI: 1.6, 3.9 for sometimes vs rarely/never worry), and higher absolute and comparative perceived BC risk (e.g., OR=2.8, 95% CI: 1.6, 5.0 for more risk vs less risk compared to average women). Women who knew about breast density also perceived less mammography benefits for earlier detection of breast tumors (OR=0.2, 95% CI: 0.1, 0.5) and reduced BC mortality (OR=0.4, 95% CI: 0.2, 0.6). In conclusion, dense breast notification to women with high MBD increases general and personal awareness of breast density; however, awareness remains low in women with racial/ethnic minority and lower socioeconomic backgrounds due to lower prevalence of dense breasts in these population groups. Dense breast notification increases feelings of worry and perceptions of future risk of breast cancer and reduces perceptions of mammography benefits, which may affect breast cancer screening participation.
Citation Format: Mariangela D. Agovino, Carmen B. Rodriguez, Mary Beth Terry, Rachel Shelton, Karen Schmitt, Elise Desperito, Ying Wei, Rita Kukafka, Parisa Tehranifar. Dense breast notification, breast density awareness, and breast cancer-related cognition and emotions in a predominantly Hispanic screening population [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C095.