Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Psychosocial and health service impact of breast density notification in Australia: a co-designed program-embedded randomised controlled trial (#455)

Brooke Nickel 1 , Nick Ormiston-Smith 2 , Jennifer Isautier 1 , Erin Cvejic 1 , Lisa Hammerton 3 , Karen Baker 4 , Paula Legerton 2 , Paul Vardon 2 , Paul Beck 2 , Meagan Brennan 5 6 , Kirsten McCaffery 1 , Sandy Robertson 7 , Nehmat Houssami 8
  1. School of Public Health, The University of Sydney, Sydney, NSW, AU
  2. Cancer Screening Unit, Queensland Department of Health, Brisbane, QLD, AU
  3. BreastScreen Queensland Sunshine Coast Service, Nambour, QLD, AU
  4. BreastScreen Queensland Brisbane Northside Service, Brisbane, NSW, AU
  5. Westmead Breast Cancer Institute, Westmead, NSW, AU
  6. University of Notre Dame Australia, Sydney, NSW, AU
  7. BreastScreen Queensland Consumer Reference Group, Brisbane, NSW, AU
  8. The Daffodil Centre, A joint venture between Cancer Council NSW and The University of Sydney, Sydney, NSW, AU

Aims: Robust evidence on the benefits and harms of breast density notification is required to inform mammography screening policy and practice in Australia and internationally. This randomised controlled trial (RCT) aimed to assess the effect of notifying women with dense breasts participating in population-based breast cancer screening of their breast density on (i) their psychosocial outcomes and (ii) health services use; and to determine whether using different modes of communication alters these effects.

Methods: Co-designed prospective 3-arm RCT: standard care (no notification of breast density) vs. notification of breast density plus a hard-copy written health literacy sensitive information vs. notification of breast density plus a link to online written and video-based health literacy sensitive information. Women attending for mammography screening at BreastScreen Queensland services (11 sites), who were classified as having dense breasts (BI-RADS C and D from automated density) were randomised. Primary outcome measures were psychological and health service use. Secondary outcome measures were cancer worry, perceived risk, breast density knowledge, future mammogram screening, and acceptability. Baseline demographic screening data and self-report data are being collected from women over a >2-year follow-up period (8-10-week, 12- and 27-month timepoints).

Results: 12,637 women consented into the RCT, with 32% having dense breasts. 3107 women were eligible and randomised including 257 women with a family history of breast cancer, 149 with non-English first languages and 39 Indigenous. A sub-sample of 50 women from the intervention arms completed qualitative semi-structed interviews. Descriptive data and initial results will be presented.

Conclusions: This is the first program-embedded RCT in the world to test the immediate and downstream impact of breast density notification on women and health services prior to systemic implementation. It will provide evidence to minimise potential harms and map out consequences of population-based breast density notification.