Breast cancer is the leading cause of cancer mortality among Hispanic women/Latinas. Increasing attention has been given to the association between breast cancer and mammographic breast density (MBD), as dense breast tissue is associated with reduced sensitivity of mammograms, masking tumors on the mammogram, and delays in diagnosis. Approximately 50% of women have dense breasts, with 10-12% of Latinas having extremely dense tissue. Legislation is advancing in the U.S. that mandates women are informed of their breast density and that they may benefit from additional screening tests if they have dense breast tissue. The effect of providing women with notification about their MBD and its impact on breast cancer risk with no other contextual information may have unintended consequences, particularly among Latinas with lower health literacy and limited resources. The likelihood of disparities emerging between women who can pursue supplemental breast screening and women who are less able to do so is also an important consideration. This proposal will examine important outcomes among women of relative socioeconomic disadvantage by implementing a prospective, 3 group randomized trial including 2,000 Latinas 40-74 years of age attending screening mammography that compares usual care to two educationally enhanced approaches to notification on anxiety, knowledge, and subsequent mammography screening adherence. Our study includes a comprehensive set of psychological measures, 1- and 2-year behavioral outcomes as well as qualitative inquiry and cost analysis to enhance our understanding of an educational intervention's delivery in practice and its transferability to other health care settings. Conducting this study in the context of newly enacted legislation and in a community setting that provides mammography screening to Latinas who are under- or uninsured will provide critical data that can inform future policy at the state and national level and impact clinical practice.
This research will assess important psychological and behavioral outcomes of emerging mandates that women undergoing screening mammography be informed of their breast density and evaluate whether educational enhancement of breast density notification to Latinas is beneficial. Conducting this research in a setting and population vulnerable to disparities that can result from this legislation is imperative and will have significant public health impact by providing evidence to guide future legislation and implementation in clinical practice.
