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Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts. [ABSTRACT FROM AUTHOR]

Evidence is required on whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice. This study aimed to assess the effect of breast density information provision on women's intention to seek supplemental screening and psychological outcomes. We conducted a three-arm online randomised experiment with Australian women aged 40-74 years with no prior history of breast malignancy, residing in jurisdictions without existing population-based breast density notification. Women were randomised to receive one of three hypothetical breast screening result letters: screening mammogram result letter without breast density messaging (control); screening mammogram result letter with breast density messaging and an existing information letter (intervention one); and screening mammogram result letter with breast density messaging and a health literacy sensitive information letter (intervention two). Primary outcomes were intention to seek supplemental screening, feeling anxious (uneasy, worried, or nervous), informed, confused, and breast cancer worry. A total of 1420 women were randomized and included in the final analysis. Compared to the control (n=480), women who received density notification via intervention one (n=470) and intervention two (n=470) reported significantly higher (p<0.001) intention to seek supplemental screening (0.8% vs 15.6% and 14.2%), feeling anxious (14.2% vs 49.4% and 48.5%), confusion (7.8% vs 24.1% and 23.6%), and worry about breast cancer ('quite/very worried' 6.9% vs 17.2% and 15.5%). There were no statistical differences in these outcomes between the two intervention groups. Breast density information integrated with screening mammogram results are likely to increase women's intention to seek supplemental screening, and to potentially make women feel anxious, confused, or worried about breast cancer. These Findings: have important relevance and implications for mammogram screening services and policymakers considering whether, and how best, to implement widespread notification of breast density as part of mammography screening. [ABSTRACT FROM AUTHOR]