Impact of population based breast density notification: multisite parallel arm randomised controlled trial in BreastScreen.
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| Názov: | Impact of population based breast density notification: multisite parallel arm randomised controlled trial in BreastScreen. |
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| Autori: | Nickel B; Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, NSW, Australia brooke.nickel@sydney.edu.au.; Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, NSW, Australia., Ormiston-Smith N; Cancer Screening Unit, Queensland Department of Health, Brisbane, QLD, Australia., Cvejic E; Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, NSW, Australia., Isautier J; Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, NSW, Australia.; Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, NSW, Australia., Hammerton L; BreastScreen Queensland Sunshine Coast Service, Nambour, QLD, Australia., Baker K; BreastScreen Queensland Brisbane Northside Service, Brisbane, QLD, Australia., Legerton P; Cancer Screening Unit, Queensland Department of Health, Brisbane, QLD, Australia., Vardon P; Cancer Screening Unit, Queensland Department of Health, Brisbane, QLD, Australia., McInally Z; Cancer Screening Unit, Queensland Department of Health, Brisbane, QLD, Australia., Robertson S; Public representative, BreastScreen Queensland Consumer Reference Group., McCaffery K; Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, NSW, Australia.; Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, NSW, Australia., Houssami N; Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, NSW, Australia.; The Daffodil Centre, The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia. |
| Zdroj: | BMJ (Clinical research ed.) [BMJ] 2025 Dec 03; Vol. 391, pp. e083649. Date of Electronic Publication: 2025 Dec 03. |
| Spôsob vydávania: | Journal Article; Randomized Controlled Trial; Multicenter Study |
| Jazyk: | English |
| Informácie o časopise: | Publisher: British Medical Association Country of Publication: England NLM ID: 8900488 Publication Model: Electronic Cited Medium: Internet ISSN: 1756-1833 (Electronic) Linking ISSN: 09598138 NLM ISO Abbreviation: BMJ Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : British Medical Association |
| Výrazy zo slovníka MeSH: | Breast Density* , Breast Neoplasms*/psychology , Breast Neoplasms*/diagnosis , Breast Neoplasms*/diagnostic imaging , Mammography*/psychology , Early Detection of Cancer*/psychology , Early Detection of Cancer*/methods , Mass Screening*/methods , Mass Screening*/psychology, Humans ; Female ; Middle Aged ; Queensland ; Adult ; Health Literacy ; Aged ; Anxiety |
| Abstrakt: | Objective: To investigate the effect of notifying women of their dense breasts on their psychosocial outcomes and health service use intentions. Design: Multisite parallel arm randomised controlled trial. Setting: Population based breast screening programme in Queensland, Australia. Participants: Women aged ≥40 years having screening and classified as having mammographically dense breasts (BI-RADS C-D from automated density measure). Intervention: Women were randomised equally to standard care (no notification of breast density), notification of breast density plus written health literacy sensitive information (intervention 1), or notification of density plus a link to online video based health literacy sensitive information (intervention 2). Main Outcome Measures: Psychological (feeling anxious, confused, or informed) and health service use intentions (general practitioner consultation related to breast density, supplemental screening) at 8 weeks post-screening. Results: Between September 2023 and July 2024, 3107 women (1030 control, 1003 intervention 1, and 1074 intervention 2) were randomised, and 2401 women (802 control, 776 intervention 1, and 823 intervention 2) with a mean age at baseline of 57.4 (standard deviation 9.9) years were included in the analysis. Compared with the control group, women who were notified of their dense breasts reported feeling significantly more anxious (intervention 1: odds ratio 1.30, 95% confidence interval (CI) 1.08 to 1.57; intervention 2: odds ratio 1.28, 1.07 to 1.54) and confused (intervention 1: odds ratio 1.92, 1.58 to 2.33; intervention 2: odds ratio 1.76, 1.46 to 2.13) and had significantly higher intentions to talk to their general practitioner about their screening results (intervention1: relative risk ratio 2.08, 95% CI 1.59 to 2.73; intervention 2: relative risk ratio 1.71, 1.31 to 2.25) and to rely on their general practitioner for supplemental screening advice (intervention 1: relative risk ratio 2.61, 1.80 to 3.79; intervention 2: relative risk ratio 2.29, 1.58 to 3.33). However, most women did not intend to have supplemental screening (control: 91.3%; intervention 1: 78.9%; intervention 2: 81.4%). Notified women did not feel more informed (intervention 1: odds ratio 0.83, 0.68 to 1.01; intervention 2: odds ratio 0.80, 0.66 to 0.97). Conclusions: Women notified of their dense breasts felt anxious and confused, did not feel more informed to make decisions about their breast health, and wanted to be guided by their general practitioners. Notification of breast density as part of population based breast screening may have adverse outcomes including additional consultation burden on general practitioners to advise women. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12623000001695). (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
| References: | J Am Coll Radiol. 2013 Dec;10(12):903-8. (PMID: 24295938) Lancet. 2025 May 31;405(10493):1887-1889. (PMID: 40412424) Perspect Psychol Sci. 2014 Mar;9(2):111-25. (PMID: 26173249) N Engl J Med. 2019 Nov 28;381(22):2169-2170. (PMID: 31774964) Br J Radiol. 2023 Dec;96(1152):20230122. (PMID: 37751169) BMJ Open. 2021 Aug 18;11(8):e047513. (PMID: 34408038) Med J Aust. 2023 Nov 6;219(9):423-428. (PMID: 37751916) J Am Coll Radiol. 2020 Mar;17(3):391-404. (PMID: 31756308) JNCI Cancer Spectr. 2024 Nov 1;8(6):. (PMID: 39392432) J Womens Health (Larchmt). 2022 Jul;31(7):983-990. (PMID: 35230164) J Womens Health (Larchmt). 2021 Oct;30(10):1457-1468. (PMID: 33656924) J Gen Intern Med. 2021 Apr;36(4):938-945. (PMID: 32935318) Patient Educ Couns. 2022 Mar;105(3):632-640. (PMID: 34238650) BMC Womens Health. 2025 Jun 2;25(1):274. (PMID: 40452038) Can J Nurs Res. 2007 Mar;39(1):38-57. (PMID: 17450704) Cancer Epidemiol Biomarkers Prev. 2000 Sep;9(9):973-5. (PMID: 11008917) Ann Intern Med. 2016 Feb 16;164(4):268-78. (PMID: 26757021) CA Cancer J Clin. 2014 May-Jun;64(3):186-94. (PMID: 24647877) J Natl Cancer Inst. 2025 Jun 1;117(6):1271-1275. (PMID: 39475439) BMC Fam Pract. 2006 Mar 24;7:21. (PMID: 16563164) N Engl J Med. 2019 Nov 28;381(22):2091-2102. (PMID: 31774954) J Natl Cancer Inst. 2021 Nov 2;113(11):1476-1483. (PMID: 34585249) J Gen Intern Med. 2020 Jun;35(6):1923-1925. (PMID: 31845108) JAMA Netw Open. 2022 Jun 1;5(6):e2216784. (PMID: 35708691) BMJ Evid Based Med. 2021 Dec;26(6):309-311. (PMID: 32665223) BMJ. 2024 Sep 18;386:q2045. (PMID: 39293857) Lancet. 2025 May 31;405(10493):1935-1944. (PMID: 40412427) J Gen Intern Med. 2019 Apr;34(4):591-597. (PMID: 30091121) N Engl J Med. 2007 Jan 18;356(3):227-36. (PMID: 17229950) JAMA Netw Open. 2023 Nov 1;6(11):e2344850. (PMID: 38010653) Med Care. 1992 Jun;30(6):473-83. (PMID: 1593914) J Womens Health (Larchmt). 2025 Apr;34(4):491-503. (PMID: 39969957) J Womens Health (Larchmt). 2021 Nov;30(11):1529-1537. (PMID: 34582721) Eur Radiol. 2019 Apr;29(4):1762-1777. (PMID: 30255244) Ann Intern Med. 2015 May 19;162(10):673-81. (PMID: 25984843) J Natl Cancer Inst. 2021 Oct 1;113(10):1299-1328. (PMID: 33544867) Breast Cancer Res Treat. 2021 May;187(1):11-30. (PMID: 33774734) BMC Health Serv Res. 2022 Mar 1;22(1):279. (PMID: 35232455) Cancer. 2020 Apr 15;126(8):1614-1621. (PMID: 31977078) J Epidemiol Community Health. 1994 Feb;48(1):65-73. (PMID: 8138773) Breast Cancer Res. 2020 Sep 29;22(1):101. (PMID: 32993747) Med Decis Making. 2020 May;40(4):545-550. (PMID: 32522094) J Natl Cancer Inst. 2014 Sep 12;106(10):. (PMID: 25217577) JAMA. 2023 Jan 10;329(2):121-122. (PMID: 36508205) |
| Entry Date(s): | Date Created: 20251203 Date Completed: 20251203 Latest Revision: 20251207 |
| Update Code: | 20251207 |
| PubMed Central ID: | PMC12673659 |
| DOI: | 10.1136/bmj-2024-083649 |
| PMID: | 41338600 |
| Databáza: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstrakt: | Objective: To investigate the effect of notifying women of their dense breasts on their psychosocial outcomes and health service use intentions.<br />Design: Multisite parallel arm randomised controlled trial.<br />Setting: Population based breast screening programme in Queensland, Australia.<br />Participants: Women aged ≥40 years having screening and classified as having mammographically dense breasts (BI-RADS C-D from automated density measure).<br />Intervention: Women were randomised equally to standard care (no notification of breast density), notification of breast density plus written health literacy sensitive information (intervention 1), or notification of density plus a link to online video based health literacy sensitive information (intervention 2).<br />Main Outcome Measures: Psychological (feeling anxious, confused, or informed) and health service use intentions (general practitioner consultation related to breast density, supplemental screening) at 8 weeks post-screening.<br />Results: Between September 2023 and July 2024, 3107 women (1030 control, 1003 intervention 1, and 1074 intervention 2) were randomised, and 2401 women (802 control, 776 intervention 1, and 823 intervention 2) with a mean age at baseline of 57.4 (standard deviation 9.9) years were included in the analysis. Compared with the control group, women who were notified of their dense breasts reported feeling significantly more anxious (intervention 1: odds ratio 1.30, 95% confidence interval (CI) 1.08 to 1.57; intervention 2: odds ratio 1.28, 1.07 to 1.54) and confused (intervention 1: odds ratio 1.92, 1.58 to 2.33; intervention 2: odds ratio 1.76, 1.46 to 2.13) and had significantly higher intentions to talk to their general practitioner about their screening results (intervention1: relative risk ratio 2.08, 95% CI 1.59 to 2.73; intervention 2: relative risk ratio 1.71, 1.31 to 2.25) and to rely on their general practitioner for supplemental screening advice (intervention 1: relative risk ratio 2.61, 1.80 to 3.79; intervention 2: relative risk ratio 2.29, 1.58 to 3.33). However, most women did not intend to have supplemental screening (control: 91.3%; intervention 1: 78.9%; intervention 2: 81.4%). Notified women did not feel more informed (intervention 1: odds ratio 0.83, 0.68 to 1.01; intervention 2: odds ratio 0.80, 0.66 to 0.97).<br />Conclusions: Women notified of their dense breasts felt anxious and confused, did not feel more informed to make decisions about their breast health, and wanted to be guided by their general practitioners. Notification of breast density as part of population based breast screening may have adverse outcomes including additional consultation burden on general practitioners to advise women.<br />Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12623000001695).<br /> (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
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| ISSN: | 1756-1833 |
| DOI: | 10.1136/bmj-2024-083649 |