Introduction of breast density notification within BreastScreen South Australia - Results of an online client survey.

Objective: Breast density is one of the strongest predictors of breast cancer risk and significantly reduces the sensitivity of mammography to detect breast cancer. Breast density notification is becoming increasingly common within screening programs in Australia. This opportunistic study evaluates client response to the introduction of breast density notification within BreastScreen South Australia, including their level of understanding, approval of notification and future screening behaviours.

Method: Clients attending three screening clinics (N=14,833) were notified by BreastScreen South Australia of their mammographic breast density, measured by the software program Volpara. Breast density was categorised as follows: A-almost entirely fatty tissue, B-scattered dense tissue, C-heterogeneously dense tissue or D-extremely dense tissue.

Results: Of the 5,137 survey respondents (34.6%), 90% supported continued reporting of breast density in the program. Around two-thirds of respondents (65%) felt informed to make decisions regarding their breast care and nearly all (98.5%) intended to continue breast screening. Anxiety in response to breast density notification was reported by 9% of all respondents (4.5% with breast density categories A/B vs 16.6% with categories C/D) and 14% reported confusion (10.7% with breast density categories A/B vs 19.9% with categories C/D). All notified women were and invited to participate in a follow-up survey to assess their response to breast density notification. Over 22% did not know breast density is associated with breast cancer risk and 55% were unsure.

Conclusion: Breast density notification was well received by most clients; however, knowledge about associated risk is considered low.

Implications For Public Health: Additional new strategies are required to better engage with general practitioners and clients, to improve breast density education and to develop a personalised screening program in the future.