How to fix a big problem with state-mandated breast density notifications

State-mandated breast density notifications (BDNs) are too complex for all patients to understand, according to new findings published in the Journal of the American College of Radiology. Simplifying the language of BDNs could make a significant impact on patient care.

“To realize the full benefits and intent of BDNs, it is critical that women understand these state-mandated communications,” wrote Derek L. Nguyen, MD, Johns Hopkins Medicine in Baltimore, and colleagues. “Thus, a study to assess the impact of the language in these notifications is timely and relevant.”

Nguyen et al. calculated the readability of Maryland’s mandated BDN using several methods, including the automated readability index, Coleman-Liau index, Gunning fog index, Flesch-Kincaid grade level, Flesch-Kincaid reading ease and Simple Measure of Gobbledygook. A revised notification with the same information was then developed, with the team confirming it had a lower Flesch-Kincaid grade level (4.9) compared to the original (12.2).

To compare patient reactions to the old and revised BDN, 500 patients were surveyed at four outpatient breast imaging centers between January and February 2019. Half of the surveys showed participants the old BDN first and then the revised BDN. For the other surveys, participants saw the revised BDN first and then the original BDN.

Patient responses provided examples of how the revised BDN improved its readability. For example, women were much less likely to overestimate their breast cancer risk after reading the revised BDN statement. While 56.6% of women reading the original BDN thought dense breast tissue automatically indicated a “high” lifetime breast cancer risk, that number was just 2.2% after reading the revised BDN. Patients were also much more likely to initiate discussions with their healthcare providers about breast density after reading the revised BDN (96%) than after reading the original BDN (32.8%).

“Our study emphasizes that clarity in these notifications may encourage women to have an active voice in their own personalized care,” the authors wrote. “Therefore, it is imperative to revise any BDN written higher than an eighth grade level to decrease misperceptions related to breast cancer risk associated with dense breast tissue. In addition, it is important to include a definition of dense breast tissue to provide women with clinical context and to facilitate understanding of the notification.”