After hypothetical breast density notification, screening interest grows

Women who received sample breast density notifications were more likely to undergo breast cancer screenings, according to a new study published online Nov. 4, 2014, in the Journal of the American College of Radiology.

The research team, including lead author Vivian M. Yeh, PhD, with the Ichan School of Medicine at Mount Sinai in New York City, sought to study how women older than 40 years responded to hypothetical dense breast tissue notification.

“Notifications often include information that dense breast tissue may increase the risk for cancer but do not state to what extent, leaving women to interpret the notifications for themselves,” Yeh and colleagues wrote. “Subsequently, patients’ perceived breast cancer risk and anxiety may increase, which is important because both perceived risk and anxiety are known to increase intentions to undergo mammography.”

They also sought to examine if their intentions for further study (mammography, ultrasound covered by insurance and ultrasound not covered by insurance) were influenced or hindered by factors like demographics, notification complexity, aversion to medical tests, mistrust of healthcare systems and active control preference in decision making.

For the study, the research team reached out to participants on Amazon Mechanical Turk (AMT), a marketplace that offers human intelligence tasks (HITs) for participants to complete for compensation. The team reached out to female AMT workers who were older than 40 and had no previous cancer diagnoses. A total of 184 women completed the AMT test and were compensated $1.

After reading the sample notification of breast density, the majority of women taking the test reported a greater perceived risk and planned to undergo mammography.

Most also intended to undergo additional ultrasound screening.

“Anxiety significantly increased all screening intentions, and the degree to which a woman felt anxiety after reading the notification mediated the relationship between her perceived cancer risk and how strongly she intended to screen,” the authors wrote. “Although two women could hold similar levels of perceived risk, it is the amount of anxiety a woman experiences that determines how motivated she is to screen.”

Additionally, the researchers found that minorities had greater intentions for ultrasound when it was covered by insurance, similar to women with greater healthcare distrust when ultrasound was not covered by insurance.

“These results are somewhat surprising, as distrust and minority status typically relate to less health care use,” Yeh and colleagues wrote.

The authors concluded that additional studies were necessary to determine if screening intentions correlated to screening behaviors.

“Although fewer women intended to undergo ultrasound when it was not covered by insurance, there were no differences in screening intentions as a function of current insurance status, income, or full-time employment,” they wrote. “Individual differences between who opts for ultrasound as a function of insurance coverage may widen when screening behavior is studied instead of intentions.”