Womens' Breast Cancer Screening Confidence by Breast Density and Screening Modality

Authors: Tosteson AN, Schifferdecker KE, Wernli KJ, Kaplan CP, Henderson LM, Sprague BL, Buist DS, Onega T, Smith RE, Budesky J, Jackson-Nefertiti G, Johnson D, Miglioretti DL, Kerlikowske K

Category: Early Detection & Risk Prediction
Conference Year: 2020

Abstract Body:
A majority of states have breast density reporting laws, and a recent Food and Drug Administration rule will make breast density reporting mandatory in all states. We sought to characterize womens breast cancer screening confidence by breast density and imaging modality for women undergoing screening with digital mammography (DM), digital breast tomosynthesis (DBT), and/or breast magnetic resonance imaging (MRI).Methods: Online or paper surveys were conducted among women ages 40-74 within 12 months of a negative breast cancer screen through the Breast Cancer Surveillance Consortium. For Group 1, women with DM vs. DBT were invited based on age and density. For Group 2, women with a screening MRI within the prior 24 months were frequency-matched to women with DM or DBT alone based on age, density, and family history of breast cancer. Confidence in breast cancer screening as reported on a 4-point scale (Very, Somewhat, A little, Not at all confident) was studied according to breast density (dense/non-dense). Results: Overall, 1,977 of 7,146 women invited (28%) completed surveys. Group 1 included 602 DM (306 dense, 296 not) and 720 DBT (384 dense, 336 not). Group 2 included 342 DM or DBT (231 dense, 111 not) and 313 MRI (210 dense, 103 not). Breast cancer screening confidence was high with 40% being very confident and 54% somewhat confident that their screening test will find breast cancer if they have it. There were no differences by imaging modality within Group 1, though a lower proportion were very confident among women with dense vs. non-dense breasts (34% vs. 47%, p<0.001, respectively). For Group 2, screening confidence for women undergoing MRI was significantly higher than DM/DBT screeners (very confident; 48% vs. 35%, p<0.001). Significant modality differences in confidence persisted among women with dense breasts (44% MRI vs. 31% DM/DBT, p<0.009) and were of borderline significance for women with non-dense breasts (56% MRI vs. 43% DM/DBT, p=0.071). Conclusion: Womens breast cancer screening confidence was lower among women with dense breasts regardless of whether they underwent DM with or without supplemental (DBT or MRI) screening. Screening confidence was higher for women who underweight MRI screening regardless of breast density.

Keywords: Breast Cancer Screening, Breast Density