Breast density notification—Australia's turn?
Associate Professor Gelareh Farshid, of BreastScreen South Australia has released a perspective supporting routine reporting of breast density in the Australian breast screening program. While density can mask breast cancers during screening, and also acts as an independent risk factor for developing breast cancer in the future, BreastScreen SA does not make recommendations to inform women of their density.
One concern in the lack of budget provided to BreastScreen Australia for supplemental screening of women with dense breasts (for instance with ultrasound, digital breast tomosynthesis or magnetic resonance imaging). This is in spite of the fact that such supplemental screening can find from 1 875 to 21 450 additional breast cancers per 1.5 million women with dense breasts who have negative mammography results (as based on estimates from the US Preventive Services Task Force). Another point is that “informing women they are at increased cancer risk without providing risk mitigation advice only leads to anxiety”.
However, Dr Farshid points out that withholding density information from women is not a solution: “…in the event of an interval cancer, this stance may be viewed as patronizing and risks damaging the trust that is fundamental in any therapeutic relationship.” She notes that density information can give women the choice to seek supplemental screening themselves, and contributes to shared decision-making in women’s healthcare. She concludes that “Screening services should be supported financially, logistically and politically to make [mammographic density] information routinely available to all their clients” and more research and dialogue should be undertaken to establish the best path ahead in regards to breast density notification.