Dr. Parisa Tehranifar, Mailman School assistant professor of epidemiology, was awarded an ROI grant of $2.78 million from the National Institutes of Health/ National Institute on Minority Health and Health Disparities (NIH/NIMHD) to study the impact of disclosure of clinical breast density information in racially diverse populations. Dr. Tehranifar and colleagues plan to enroll and follow a large sample of women to prospectively examine how breast density notification relates to a broad range of screening-relevant psychological outcomes and subsequent screening behaviors.
High mammographic breast density, reflecting the extent of radiographically dense breast tissue on a mammogram, reduces the sensitivity of mammography for detecting breast tumors, and is a strong risk factor for breast cancer risk. New York is one of a growing number of states that has recently mandated for the direct release of mammographic breast density information to women found to have heterogeneously or extremely dense breasts on their mammograms. New York State women with dense breasts receive a written notification that informs them about the lower sensitivity of mammography and increased breast cancer risk associated with having dense breasts, and advises them to consult their physicians about risk assessment and need for additional screening. Nationally, over 40 percent of screened women, aged 40-74 years, or over 27 million U.S. women are estimated to fall into the category of having dense breasts as defined by the legislation.
“There have been few large-scale systematic evaluations of whether and how disclosure of personal breast density information affects women’s perceptions, attitudes and behaviors towards breast cancer early detection,” said Dr. Tehranifar. “In particular, we believe inadequate attention has been devoted to understanding potentially adverse implications of breast density notification for breast cancer disparities.”
African American and Hispanic women have higher risks of late stage breast cancer diagnosis and death after breast cancer than White women. Similar patterns are seen for lower socioeconomic groups. The disclosure of mammographic breast density information may provide new opportunities for clinical risk assessment and more informed decisions about breast cancer screening; however, women with more limited resources (e.g., less education, insurance coverage) may be less able to act on this information. Prior research, including studies by Mailman School researchers, have found that emerging health-enhancing information and medical interventions can exacerbate health disparities as less benefits are gained by racial minorities and those with lower socioeconomic status.
“In order to avoid any potential increases in social disparities in breast cancer early detection, there is a critical need to compare the impact of the law in promoting appropriate breast cancer screening in all population groups”, noted Dr. Tehranifar. “Our goal is to learn as much as about women’s psychosocial and behavioral responses to personal clinical breast density information, particularly in populations experiencing a heavy breast cancer morbidity and mortality.”