Women of lower socioeconomic circumstances are just as interested in learning about breast tissue density following mammography as their higher-income counterparts, but may be unwilling to undergo supplemental screenings due to associated costs, revealed a study published in the March issue of the Journal of the American College of Radiology.

It is believed that nearly half of women in the U.S. have mammographically dense breast tissue. This condition presents a dual challenge for patients and their doctors, as it renders breast cancer detection through mammography more difficult and increases the chances of breast cancer development in the future. Because of this, legislation requiring doctors to inform their patients of increased breast tissue density and options for supplemental screening has been passed in 21 states and the Breast Density and Mammography Reporting Act awaiting consideration at the federal level.

But not everyone with dense breast tissue may need additional screenings, according to lead author Long Trinh, MD, of Stanford University Medical Center, and colleagues. “Currently, the National Comprehensive Cancer Network and the American Cancer Society do not recommend supplemental screening for women with dense breasts who are not at high risk on the basis of family history,” wrote Trinh et al. “Given the lack of evidence-based guidance and financial support for supplementary screening tests for women with dense breasts, the outcome of … legislation may depend on an individual woman’s motivation and her financial capability to undergo supplemental screening.”

To get a clearer picture of existing knowledge and attitudes about breast tissue density and the prospect of additional screenings, Trinh and his team surveyed women undergoing mammography at two separate facilities—an academic medical center and a county hospital. The survey included questions regarding patients’ awareness of breast tissue density, willingness to know their own breast density levels and opinions on supplemental screenings.

The results showed that 23 percent of women from the academic facility already knew their breast density, compared to only 5 percent of women from the county hospital. Most patients at both sites— 94 percent and 79 percent, respectively—showed an interest in learning their breast density levels. The greatest disparities came on questions regarding supplemental screenings, with only 22 percent of women at the county hospital willing to pay out-of-pocket for additional testing, compared to 70 percent of women at the academic facility.

This is a troubling statistic when considering equal access to healthcare, according Trinh and his colleagues. “Women at the county hospital were less willing to incur out-of-pocket expenses, suggesting a potential for a disparity in health care access for women of lower socioeconomic status after the enactment of breast density notification legislation,” the authors wrote. “More efforts are required to enable lower socioeconomic status women to obtain access to supplemental testing that may be prompted by the density notification law. An analysis of insurance coverage for supplemental screenings is also needed, particularly for indigent women and in light of the Patient Protection and Affordable Care Act.”