Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women

Perceptions of breast cancer risk after breast density notification in a population-based screening program

BACKGROUND

Despite increasing evidence to support risk-based breast cancer screening, individuals' understanding of personal risk is not well understood. This study compares women's perceptions of risk to their estimated risk, and examines factors associated with perceived risk, including breast density notification, within a population-based screening program.

METHODS

A survey of 5784 women measured their perceived risk via three questions: a number from 0 to 100 (numeric), a category from very low to very high (verbal), a comparative category relative to an average woman (comparative). Descriptive analyses assessed correlations between perceived risk variables and estimated risk (using the Gail Model), and modelled relationships using K-fold cross-validation. A Graded Response Model was used to obtain an index of unobserved (latent) overall perceived risk from the three questions. Multivariable modelling was used to investigate factors associated with overall perceived risk.

RESULTS

Most participants perceived themselves as being at neither high nor low risk, although perceived risk was higher than estimated risk, on average. All three perceived risk measures were positively correlated with each other and with estimated risk. Overall perceived risk was weakly associated with estimated risk (adjusted R2 = 0.12). Women who received multiple breast density notifications, were younger, or had a family history, perceived their risk as higher relative to respective reference groups. Those who identified as Asian perceived their risk as lower than those who identified as European/Caucasian.

CONCLUSION

Individuals' understanding of breast cancer risk is poor. New strategies are needed to improve education and awareness of personal risk.

Factors influencing clinical breast cancer screening: A cross-sectional study among Islamic women in Kumasi Metropolis of Ghana

Clinical breast cancer screening among Ghanaian women is generally unsatisfactory due to poor knowledge despite its critical role in the early detection of breast cancer. Available studies in Ghana show that Islamic women have poorer screening rates which may be due to sociocultural and religious barriers. Understanding the factors that influence clinical breast cancer screening among Islamic women is a critical step that can help the design of initiatives to increase screening among Muslim populations in Ghana. Therefore, this study aimed to explore the factors influencing clinical breast cancer screening among Islamic women in the Kumasi Metropolis of Ghana. From August 20, 2024, to November 01, 2024, a community-based cross-sectional systematic sampling technique was deployed in the Aboabo and Asawase communities of the Ashanti Region to select 500 Islamic women for the study. Binary logistic regression was employed to determine the relationships between variables. Outcome variables with P-values < 0.05 were considered statistically significant. Most of the respondents were of Ghanaian Northern ancestry, with secondary-level education as the highest educational attainment. Compared to women with low cultural and religious norms, women with stronger personal and religious norms had 0.61 lower odds of screening (aOR=0.61, 95% CI = 0.34-1.08). Participant's level of religiosity had a significant association with clinical breast cancer screening, with 1.16 times higher odds of screening (aOR= 1.16, 95% CI = 1.02-1.32) after adjusting for the covariates. Islamic women perceived high benefits of clinical breast cancer screening but fear of personal and social norm violations at the screening centers and poor knowledge about breast cancer limited their actual participation in clinical breast cancer screening practices. Implementing a national breast cancer education campaign to emphasize the need for asymptomatic or routine screening and provider training on culturally competent practices is encouraged.

The Impact of Breast Density Notification on Anxiety in South Australian Women Undergoing Breast Cancer Screening

Purpose: The purpose was to investigate the impact of breast density notification on anxiety using the State and Trait Anxiety Inventory (STAI) tool in South Australian women undergoing breast cancer screening. Methods: A survey-based cross-sectional mixed method study was conducted in women attending breast cancer screening at the Queen Elizabeth Hospital Breast/Endocrine outpatient department (n = 100). The women had participated in a previous study assessing their general knowledge of breast density and had indicated they wanted to know their own breast density. Breast density was assessed using Volpara software, and the participants were notified by letter. The STAI tool was administered with an additional question asking how participants felt after being told their breast density. State and trait anxiety levels were compared between those receiving notification of dense breasts and those notified of nondense breasts. Results: State anxiety scores were not different between women notified they had dense breasts (n = 34, mean state anxiety ± SD; 36.65 ± 13.03) and those who had nondense breasts (n = 66, 35.17 ± 13.60, p = 0.51). Severe trait anxiety was observed in 8 of 34 (23%) and 13 of 66 (20%) women in the dense and nondense groups, respectively, and there were no significant differences. Qualitative analysis of 122 coded responses revealed the majority of reactions to breast density notification were positive or neutral, with 17% being negative. Conclusion: Notification of dense breasts was not associated with elevated anxiety when compared to the notification of nondense breasts. Breast density notification approaches need to be considerate of the significant proportion of women with severe underlying anxiety.

Evidence-based advancements in breast cancer genetic counseling: a review

PURPOSE

Understanding individuals at high risk of breast cancer, as well as patients and survivors, underscores the critical role of genetic counseling in the diagnosis and treatment of breast cancer.

METHODS

This systematic review adhered to the guidelines outlined in the Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The review process was managed using Covidence systematic review software, facilitating data extraction according to predefined eligibility criteria by two independent reviewers. Quality appraisal and narrative synthesis were conducted following data extraction.

RESULTS

Out of 1089 articles screened, nineteen (19) studies met the inclusion criteria and were included in this review. These studies were categorized into categories based on their relevance to breast cancer genetic counseling. Rapid Genetic Counseling and Testing (RGCT): 3 studies (15.78%), racial differences: 2 studies (10.52%), limited health literacy: 4 studies (21.05%), breast cancer survivorship: 3 studies (15.78%), risk perceptions and cancer worry: 5 studies (26.31%) and telephone delivery and computer aid programs: 2 studies (10.52%) based on specific focus areas of each study in relation to breast cancer genetic counseling.

CONCLUSION

Genetic counseling has shown to improve client outcomes across the majority of reviewed studies, contributing to the advancement of evidence-based practice in this field. However, to further promote evidence-based advancements in breast cancer genetic counseling, it is imperative to pay close attention to potential sources of bias and uphold rigorous quality standards in future research endeavors.

Breast density awareness and cancer risk in the UAE: Enhancing Women's engagement in early detection

INTRODUCTION

Increased breast density (BD) is significantly correlated to higher rates of breast cancer (BC), yet awareness among women remains low. This study assesses women's understanding of BD, its implications for cancer risk, and their engagement in screening practices.

METHODS

A cross-sectional survey of 212 women aged 40 to 74 was conducted using an online questionnaire developed within Google Forms, including open and closed-ended questions. Demographic information was collected, followed by BC awareness and BD knowledge questions. Data were analyzed using IBM SPSS software, with categorical data reported as numbers and percentages, and Chi-square tests employed to explore associations between variables.

RESULTS

Of the 212 participants, those with healthcare involvement were significantly more likely to recognize BD as a BC risk factor, with 25.0 % acknowledging its impact compared to 16.8 % of non-professionals (χ2 = 9.520, p = 0.009). Formal training was associated with increased engagement in breast self-examinations (BSE), with 58.6 % of trained individuals practicing BSE versus 30.1 % without training (χ2 = 9.108, p = 0.003).

CONCLUSION

Findings underscore the need for targeted educational initiatives to improve BD awareness among women in the general public, empowering them to identify as at-risk and to participate in screening programs.

IMPACT ON PRACTICE

This study emphasizes integrating BD awareness into clinical practice. Healthcare providers are encouraged to implement educational strategies that inform women of BD, its associated risks, and the value of regular screening. Enhancing self-awareness among patients may facilitate earlier detection, ultimately improving BC outcomes and public health efforts.

Awareness of Breast Cancer Risk Factors in Women with vs. Without High Breast Density

Purpose

Women with high breast density (HBD) carry an increased risk for breast cancer (BC). The aim of the study was to provide data on awareness and knowledge gaps among women with vs w/o HBD about BC risk factors (BCRFs), which is the basis for effective communication about screening.

Patients and Methods

This was a web-based survey of 3000 women aged ≥30 and ≤70 from six countries. It comprised of 45 questions. T-tests and chi-square tests with False Discovery Rate adjustments were conducted as applicable, with significant differences reported at α=0.05.

Results

Three-thousand women were included in the analysis, 733 (24.4%) had HBD. Overall, 39% of women were familiar with the concept of HBD in the context of BC. Thirty-one percent of women were aware of HBD as BCRF and for 24% of women HBD was personally applicable. A significantly higher proportion of women with HBD were aware of almost all BCRFs compared to women w/o HBD (p ≤ 0.05). Similarly, a significantly higher proportion of women with HBD have undergone screening procedures compared to women w/o HBD (p ≤ 0.05). Women with HBD were significantly better aware of basic facts about BC (p ≤ 0.05). A total of 1617 women underwent mammography, 904 ultrasound and 150 MRI during their last screening. The most relevant source of information about BC was the health care professional, as reported by 63% of women.

Conclusion

Overall 39% of women were familiar with HBD as BCRF. Lack of BCRF awareness may contribute to delayed screenings, missed opportunities for early detection, and potentially poorer outcomes for individuals with dense breast tissue. Thus, this information should be communicated more widely.

The triad of knowledge, regular medical consultation, and recommendations for enhanced breast cancer screening intention in Morocco

PURPOSE

The low rate of breast cancer screening in Morocco is linked to delayed diagnosis and increased mortality rates. Furthermore, there is a lack of research on the association between screening intention and knowledge levels. Our objective was to assess the level of knowledge regarding breast cancer and screening, identify the determinants of this knowledge, and determine predictive factors for screening intention.

METHODS

A cross-sectional analytical study was conducted on 1014 women in the city of Essaouira, Morocco, during the years 2018-2020. A stepwise logistic regression analysis was performed to identify the predictors using SPSS software.

RESULTS

We found an above-average level of knowledge (67%). These knowledge levels were associated with several personal characteristics. Moreover, these knowledge levels proved to be powerful predictive factors for the intention to undergo screening, along with regular medical consultations and recommendations to undergo screening.

CONCLUSION

Women had a high level of knowledge about breast cancer and its characteristics. These knowledge levels were strongly associated with the intention to undergo screening. However, despite this, the low participation rate encourages the reinforcement of research to align knowledge, intention, and screening practices.

Anticipatory anxiety and participation in cancer screening. A systematic review

OBJECTIVES

To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates.

METHODS

Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types.

RESULTS

A total of 74 articles (nparticipants  = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening.

CONCLUSION

Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.

Survey of knowledge and awareness of breast density amongst Maltese Women undergoing mammography screening

INTRODUCTION

The ratio of breast glandular tissue to fatty tissue is known as breast density. This study assessed the knowledge and awareness of breast density of Maltese women undergoing mammography screening at the National Screening Unit. Increased breast density knowledge may lead to an increase in supplementary imaging attendance. In Europe, there are very limited studies assessing the knowledge and awareness of breast density, providing a solid rationale for this study to be done locally.

METHODS

Women aged 50 to 69 who were eligible for breast cancer screening at the National Screening Unit were given a validated closed-ended questionnaire as part of a quantitative, prospective, cross-sectional, and descriptive study. The questionnaire was designed to achieve the aims of the study. Using IBM-SPSS (v28) software, the data was analysed using the Friedman and Kruskal Wallis tests.

RESULTS

A total of 127 surveys were gathered, with a maximum margin of error of 8.66% based on a 95% confidence range. Breast density and the risks associated with it were not well known or understood (average scores ranging from 2.80 to 3.34 out of 5), but supplemental screening was more widely known (3.65). Participants' knowledge and awareness were correlated with their age, profession, and degree of education. Leaflets (40%) and medical experts (40%) were respondents' favourite sources of information.

CONCLUSION

The population under study lacks knowledge and awareness of breast density and the risks it entails. It's important to provide women more details about breast density. With this information, women will be empowered to seek the finest care.

IMPLICATIONS FOR PRACTICE

Although some socio-demographic parameters were linked to women's knowledge and awareness, it is advised that more research be done using a bigger sample size through interviews and other studies. Moreover, more information regarding breast density must be provided to women undergoing breast cancer screening in Malta to increase their knowledge and awareness.

Public awareness, specific knowledge, and worry about mpox (monkeypox): A preliminary community-based study in Shenzhen, China

Background

The mpox (monkeypox) outbreak has been declared to be a public health emergency of international concern by the Director-General of World Health Organization in July 2022. However, evidence regarding the awareness, knowledge, and worry about mpox in the general population remains scant.

Methods

A community-based survey targeting community residents was preliminarily conducted in Shenzhen, China in August 2022 by using a convenience sampling method. Information on mpox-related awareness, knowledge, and worry was collected from each participant. Binary logistic regression analyses with the stepwise procedure were applied to explore the factors associated with awareness, knowledge, and worry about mpox.

Results

A total of 1028 community residents were included in the analysis (mean age: 34.70 years). Among these participants, 77.9% had ever heard of mpox, and 65.3% were aware of the global outbreak of mpox. However, only about half of them had a high level of knowledge regarding mpox (56.5%) and related symptoms (49.7%). More than one-third of them (37.1%) expressed a high level of worry about mpox. Having high knowledge levels of mpox and related symptoms were positively associated with a high level of worry (OR: 1.79, 95%CI: 1.22~2.63 for a single high knowledge level; OR: 1.98, 95%CI: 1.47~2.66 for both high knowledge levels).

Conclusions

This study identified the gaps in public awareness and specific knowledge of mpox in Chinese people, providing scientific evidence for the prevention and control network of mpox at the community level. Targeted health education programs are of urgent need, which should be implemented along with psychological interventions to release public worry if necessary.

Implication and Influence of Multigene Panel Testing with Genetic Counseling in Korean Patients with BRCA1/2 Mutation-Negative Breast Cancer

PURPOSE

The aim of the study was to evaluate the clinical implication of multigene panel testing of beyond BRCA genes in Korean patients with BRCA1/2 mutation-negative breast cancer.

MATERIALS AND METHODS

Between 2016 and 2019, a total of 700 BRCA1/2 mutation-negative breast cancer patients received comprehensive multigene panel testing and genetic counseling. Among them, 347 patients completed a questionnaire about cancer worry, genetic knowledge, and preference for the method of genetic tests during pre- and post-genetic test counseling. The frequency of pathogenic and likely pathogenic variants (PV/LPV) were analyzed.

RESULTS

At least one PV/LPV of 26 genes was found in 76 out of 700 patients (10.9 %). The rate for PV/LPV was 3.4% for high-risk genes (17 PALB2, 6 TP53, and 1 PTEN). PV/LPVs of clinical actionable genes for breast cancer management, high-risk genes and other moderate-risk genes such as ATM, BARD1, BRIP, CHEK2, NF1, and RAD51D, were observed in 7.4%. Patients who completed the questionnaire showed decreased concerns about the risk of additional cancer development (average score, 4.21 to 3.94; p < 0.001), influence on mood (3.27 to 3.13; p < 0.001), influence on daily functioning (3.03 to 2.94; p=0.006); and increased knowledge about hereditary cancer syndrome (66.9 to 68.8; p=0.025) in post-test genetic counseling. High cancer worry scales (CWSs) were associated with age ≤ 40 years and the identification of PV/LPV. Low CWSs were related to the satisfaction of the counselee.

CONCLUSION

Comprehensive multigene panel test with genetic counseling is clinically applicable. It should be based on interpretable genetic information, consideration of potential psychological consequences, and proper preventive strategies.

General practitioners' (GPs) understanding and views on breast density in Australia: a qualitative interview study

OBJECTIVES

To understand general practitioners' (GPs') awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women.

DESIGN

Qualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis.

SETTING

Australia.

PARTICIPANTS

Australian GPs (n=30).

RESULTS

GPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD.

CONCLUSIONS

Australian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.

Effectiveness of the Korean National Cancer Screening Program in reducing breast cancer mortality

High incidences of breast cancer (BC) are reported in Asian women in their forties, and it is not clear whether mammographic screening reduces mortality among them. This study evaluated the effect of BC screening on mortality in Korea. We conducted a nationwide prospective cohort study of women invited to the Korean National Cancer Screening Program (KNCSP) between 2002 and 2003 (N = 8,300,682), with data linkage to the Korea Central Cancer Registry and death certificates through 2014 and 2015, respectively. Exposure to mammographic screening was defined using a modified never/ever approach. The primary study outcome was adjusted mortality rate ratio (MRR) for BC among screened and non-screened women estimated by Poisson regression. An adjusted MRR for all cause-death other than BC was examined to account for selection bias in the cohort. BC incidence rates for screened and non-screened women were 84.41 and 82.88 per 100,000 women-years, respectively. BC mortality rates for screened and non-screened women were 5.81 and 13.43 per 100,000 women-years, respectively, with an adjusted MRR for BC of 0.43 (95% CI, 0.41-0.44). The adjusted MRR for all-cause death excluding BC was 0.52 (95% CI, 0.52-0.52). The greatest reduction in BC mortality was noted for women aged 45-54 years, and there was no observable reduction in mortality after the age of 70 years. In conclusion, the KNCSP has been effective in reducing BC mortality among Korean women aged 40-69 years.